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Journal of Pediatric Neurology 2023; 21(06): 445-449
DOI: 10.1055/s-0043-1772574
Case Report

A Rare Occurrence of Demyelinating Lesions of Bilateral Trigeminal Nerves: An Atypical Presentation of Pediatric Multiple Sclerosis

Elia Manfrini 
1   Department of Radiology, University of Cagliari, Cagliari, Italy
,
Ludovica Falcioni 
2   Unit of Child and Adolescent Neuropsychiatry, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
3   Child Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Sassari, Italy
,
Vanna Cavassa 
2   Unit of Child and Adolescent Neuropsychiatry, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
3   Child Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Sassari, Italy
,
Eleonora Cocco 
4   Department of Medical Sciences and Public Health, Multiple Sclerosis Center, Binaghi Hospital, University of Cagliari, Cagliari, Italy
,
Stefano Sotgiu 
3   Child Neuropsychiatry Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Sassari, Italy
,
Luca Saba 
1   Department of Radiology, University of Cagliari, Cagliari, Italy
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Abstract

Pontine trigeminal root entry zone is a typical, although uncommon, location for multiple sclerosis (MS) lesions to occur. Here, we present a 17-year-old girl with nausea, vomiting, and vertigo. Neurological examination was consistent with central nystagmus, positive Romberg's test, and left-sided hyperreflexia. Baseline magnetic resonance imaging fulfilled McDonald 2017 criteria for MS and showed T2-hyperintense and T1-hypointense bilateral demyelinating lesions at the intramedullary portion of the trigeminal root of the fifth nerve, with no contrast enhancement or restricted diffusion. Bilateral intrapontine trigeminal involvement is a rare finding in MS, as well as the combined central and peripheral demyelination. Furthermore, very limited information and cases have been described in pediatric patients.

Keywords

magnetic resonance imaging - multiple sclerosis - combined central and peripheral demyelination - child - trigeminal nerve


Publikationsverlauf

Eingereicht: 29. März 2023

Angenommen: 17. Juli 2023

Artikel online veröffentlicht:
19. September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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