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A 64-year-old man with xerostomia and xerophthalmia presented with numbness over the right chin and cheek, progressing over 18 months. He chewed food exclusively on the left side, as he would bite his tongue chewing on the right. On examination, there was multimodality trigeminal sensory loss in the right maxillary (V2) and mandibular (V3) distributions, with weakness and wasting of the right masseter and temporalis muscles (figure 1A). Forehead sensation (V1) and corneal reflex were normal. MR scan of head showed atrophy of all the right-sided muscles of mastication (figure 2); there was abnormal gadolinium enhancement of the right trigeminal nerve, including its maxillary (figure 3A) and mandibular divisions (figure 4). While some enhancement of V2 and V3 is normal, the degree and asymmetry of enhancement was obviously abnormal (figures 3 and 4). The increased enhancement was limited to the nerves themselves, with no appreciable abnormal dural-based enhancement. The serum …
Contributors EPF was involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis and interpretation of data, and acquisition of data. TJK was involved in revising the manuscript for content, including medical writing for content, analysis and interpretation of data, and acquisition of data. BMK was involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis and interpretation of data, acquisition of data and study supervision.
Competing interests Eoin Flanagan has no disclosures. Dr Kaufmann has no disclosures. B Mark Keegan is compensated as a Chief Editor of eMedicine, has consulted for Bristol Meyers Squibb, Novartis and Bionest and receive research support from Terumo BCT.
Patient consent Obtained.
Ethics approval This was a case report. Patient consented to use of research for study.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Michael Lunn, London, UK and Shelley Renowden, Bristol, UK.