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Abstract

Trigeminal involvement detected by magnetic resonance imaging (MRI) in multiple sclerosis (MS) patients is usually associated with trigeminal neuralgia (TN) or painless paraesthesia in the trigeminal distribution. Our aim is to review the incidence of trigeminal involvement on MRI in a series of patients with MS at our institution, with further clinical correlation. We reviewed MRI scans of 275 MS patients for the presence of gadolinium enhancement on postcontrast T1-weighted images, anatomical and signal abnormalities on different sequences at the pontine trigeminal root entry zone (REZ) and in the cisternal portion of the nerves. We observed enhancement in the cisternal portion of the nerves and signal abnormalities (with or without enhancement) at the pontine trigeminal REZ in 8 (2.9%) patients, and enhancement was bilateral in 6 (75%) of those. Despite the inflammatory activity, none of them had TN and 3 (37.5%) had only painless paraesthesias in the correspondent V3 distribution. We also found a marked trigeminal hypertrophy in 2 (25%) patients, both with a longer period of disease. Our results confirm a high and clinically silent incidence of trigeminal involvement in MS patients, and suggest a simultaneous role of the central and peripheral type of myelin in trigeminal demyelination.

Keywords

gadolinium enhancement magnetic resonance imaging (MRI)multiple sclerosis (MS)trigeminal nerve trigeminal neuralgia trigeminal symptoms

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References

Meaney JFM , Watt JWG , Eldridge PR , Whitehouse GH , Wells JCD , Miles JB. Association between trigeminal neuralgia and multiple sclerosis: role of magnetic resonance imaging . J Neurol Neurosurg Psychiatry 1995; 59: 253-259 .

Gass A , Kitchen N , MacManus DG , Moseley IF , Hennerici MG , Miller DH. Trigeminal neuralgia in patients with multiple sclerosis: lesion localization with magnetic resonance imaging . Neurology 1997; 49: 1142-1144 .

Nakashima I , Fujihara K , Kimpara T , Okita N , Takase S , Itoyama Y. Linear pontine trigeminal root lesions in multiple sclerosis: clinical and magnetic resonance imaging studies in 5 cases . Arch Neurol 2001; 58: 101-104 .

Rushton JG , Olafson RA. Trigeminal neuralgia associated with multiple sclerosis: report of 35 cases . Arch Neurol 1965; 13: 383-386 .

Jensen TS , Rasmussen P , Reske-Nielsen E. Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features . Acta Neurol Scand 1982; 65: 182-189 .

Olafson RA , Rushton JG , Sayre GP. Trigeminal neuralgia in a patient with multiple sclerosis: an autopsy report . J Neurosurg 1966; 24: 755-759 .

van der Meijs AHC , Tan IL , Barkhof F. Incidence of enhancement of the trigeminal nerve on MRI in patients with multiple sclerosis . Mult Scler 2002; 8: 64-67 .

McDonald WI , Compston A , Edan G , Goodkin D , Hartung HP , Lublin FB et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis . Ann Neurol 2001; 50: 121-127 .

Miller DH , Barkhof F , Nauta JJ. Gadolinium enhancement increases the sensitivity of MRI in detecting disease activity in multiple sclerosis . Brain 1993; 116: 1077-1094 .

10.

Filippi M , Yousry T , Campi A , Kandziora C , Colombo B , Yoltz R et al. Comparison of triple dose versus standard dose gadolinium-DTPA for detection of MRI enhancing lesions in patients with MS . Neurology 1996; 46: 379-384 .

11.

Filippi M , Yousry T , Rocca MA , Fesl G , Comi G. Sensitivity of delayed enhanced MRI in multiple sclerosis . Proc Int Soc Magn Reson Med 1996; 1: 543-543 .

12.

Selby G. Diseases of the fifth cranial nerve. In Dyck PJ , Thomas PK , Lambert EH , Bunge R eds. Peripheral neuropathy, Volume II, second edition. Philadelphia, PA: WB Saunders , 1984: 1224-1265.

13.

Berthold CH , Carlstedt T , Corneliuson O. Anatomy of the nerve root at the central-peripheral transitional region. In Dyck PJ , Thomas PK , Lambert EH , Bunge R eds. Peripheral neuropathy, Volume I, second edition. Philadelphia, PA: WB Saunders , 1984: 156-170.

14.

Lees MB , Bizzozero OA , Quarles RH. Myelin and myelin disorders. In Dulbecco R ed. Encyclopedia of human biology, Volume 5 Mi-Ph. San Diego, CA: Academic Press , 1991: 271-284.

15.

Scherer SS , Deschenes SM , Xu YT , Grinspan JB , Fischbeck KH , Paul DL. Connexin32 is a myelin-related protein in the PNS and CNS . J Neurosci 1995; 15: 8281-8294 .

16.

Prineas JW , Barnard RO , Kwon EE , Sharer L , Cho E-S. Multiple sclerosis: remyelination of nascent lesions . Ann Neurol 1993; 33: 137-151 .

Trigeminal involvement in multiple sclerosis: magnetic resonance imaging findings with clinical correlation in a series of patients

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