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

Centro de Medicina Diagnóstica, Setor de Imagem, Laboratório Fleury, São Paulo-SP, Brazil, Section of Radiology, Santa Casa de Misericórdia de São Paulo, CEP 01333910 São Paulo-SP, Brazil, carlos.silva{at}fleury.com.br

A J da Rocha

Centro de Medicina Diagnóstica, Setor de Imagem, Laboratório Fleury, São Paulo-SP, Brazil, Section of Radiology, Santa Casa de Misericórdia de São Paulo, CEP 01333910 São Paulo-SP, Brazil

M F Mendes

Section of Neurology, Santa Casa de Misericórdia de São Paulo, CEP 01333910 São Paulo-SP, Brazil

A CM Maia, Jr

Centro de Medicina Diagnóstica, Setor de Imagem, Laboratório Fleury, São Paulo-SP, Brazil

F T Braga

Centro de Medicina Diagnóstica, Setor de Imagem, Laboratório Fleury, São Paulo-SP, Brazil, Section of Radiology, Santa Casa de Misericórdia de São Paulo, CEP 01333910 São Paulo-SP, Brazil

C P Tilbery

Section of Neurology, Santa Casa de Misericórdia de São Paulo, CEP 01333910 São Paulo-SP, Brazil

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.

Key Words: gadolinium enhancement • magnetic resonance imaging (MRI) • multiple sclerosis (MS) • trigeminal nerve • trigeminal neuralgia • trigeminal symptoms

Multiple Sclerosis, Vol. 11, No. 3, 282-285 (2005)
DOI: 10.1191/1352458505ms1186oa


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