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A 66-year-old man with maturity onset diabetes mellitus presented with a 2-month history of painless right facial ulceration (figure 1). Four months ago, he had been admitted with an abrupt-onset imbalance with vomiting and right facial numbness. Eight weeks later, a right-sided nasal ulcer appeared and gradually enlarged; the biopsy found chronic inflammatory changes.
On examination, his right pupil was small. There was right facial ulceration with trigeminal sensory loss to pinprick and temperature, and his gait was ataxic.
On reviewing the original MR scans, there were widespread ischaemic changes and a recent lateral medullary infarction (figure 2).
Trigeminal trophic syndrome, a rare complication of lateral medullary syndrome, results from a painless trauma to the face.1 Awareness of the neurological basis of the syndrome avoids inappropriate interventions. The treatment hinges on avoiding further trauma (cutting finger nails, nocturnal scratch mittens, protective facial prosthetics) and using drugs to reduce neuropathic symptoms (eg, gabapentin).
The ulceration improved over 6 months (figure 3).
This manuscript was reviewed by Lionel Ginsberg, London, UK.
Competing interests Geraint Fuller is co-editor of Practical Neurology.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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