Abstract Details

Title A Rare Case of Postherpetic Wallerian Degeneration of the Trigeminal nerve

Topic Infectious Disease

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-003

Background Neuropathic pain derived from insult to the trigeminal nerve (CN V) is termed trigeminal neuralgia (TN). The most common etiology of TN is vascular compression of CN V entering the pons, yielding myelin degradation. CN V damage - via neoplasm, arachnoid cyst, aneurysm, autoimmunity, or trauma - are infrequent triggers. PHTN refers to persistent neuralgia following treatment of herpes zoster infection.

Objective To describe a case of postherpetic trigeminal neuralgia (PHTN) leading to Wallerian degeneration of the trigeminal nerve

Design/Methods Case Study

Results A 60-year-old woman presented to our neurology clinic for follow-up evaluation of postherpetic neuralgia complicated by stabbing headaches and vomiting for several weeks. Throughout this time, the patient noted pustular lesions in the left periophthalmic region, left facial pain with numbness, blurred vision, otalgia, and perioral paresthesias. The pustular lesions resolved with valacyclovir treatment. However, the pain and sensory deficits remained. We attempted to treat her with gabapentin and pregabalin, but she did not tolerate these medications due to dizziness and fatigue. Brain MRI at that time showed a linear T2 hyperintensity of the left pontine tegmentum, extending to the left lateral C2 with suspicion for chronic demyelination. Follow-up cervical spine MRI confirmed this, and was consistent with Wallerian degeneration of the CN V spinal nuclei and brainstem tracts. Given her persistent neuropathic pain, we switched her to oxcarbazepine which seemed to improve all symptoms. However, in the following two weeks, she relapsed with intractable pain, numbness, and pruritus causing interference with daily life. Most recently, we increased the oxcarbazepine dosage and restarted pregabalin. We will consider consulting neurosurgery or pain medicine in the future if this regimen fails.

Conclusions

Insults to CN V by herpes zoster reactivation may result in extensive Wallerian degeneration of CN V and its spinal nuclei, giving rise to atypical and medically refractory symptoms of PHTN.

Authors/Disclosures
Ademilola Tejuoso PRESENTER	Ms. Tejuoso has nothing to disclose.
Erik Seroogy (University of Louisville School of Medicine)	Mr. Seroogy has nothing to disclose.
Mehyar Mehrizi, MD, FAAN (Baptist Health Medical Group)	Dr. Mehrizi has nothing to disclose.
	No disclosure on file