Pearls & Oy-sters: Trigeminal Trophic Syndrome From Lateral Medullary Stroke With Successful Multimodal Treatment

We describe an adult patient who developed widespread skin ulceration in the left trigeminal nerve distribution due to a Wallenberg syndrome from an acute ischemic stroke in the left lateral medulla. Trigeminal trophic syndrome is a rare consequence of a trigeminal nerve pathway injury characterized by the triad of persistent ulceration, anesthesia, and paresthesia of the same trigeminal dermatomes. It is an unusual complication of stroke that most likely developed in this patient from a combination of neurotrophic skin changes worsened by self-inflicted injury from scratching in a hypoesthetic region and by a psychiatric comorbidity. Skin lesions and their functional consequences significantly improved after multidisciplinary treatment including numerous surgical interventions.