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NEUROIMAGE
Year : 2013  |  Volume : 61  |  Issue : 5  |  Page : 566-567

Hypertrophic trigeminal nerves: Moustache sign


Department of Neurology, Bombay Hospital Institute of Medical Science and Research, Mumbai, Maharashtra, India

Date of Web Publication22-Nov-2013

Correspondence Address:
Satish V Khadilkar
110, New Wing, Bombay Hospital, 12, New Marine Lines, Mumbai - 400 020, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.121960

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How to cite this article:
Khadilkar SV, Visana DR, Huchche AM, Shah N, Gupta N, Bharucha NE. Hypertrophic trigeminal nerves: Moustache sign. Neurol India 2013;61:566-7

How to cite this URL:
Khadilkar SV, Visana DR, Huchche AM, Shah N, Gupta N, Bharucha NE. Hypertrophic trigeminal nerves: Moustache sign. Neurol India [serial online] 2013 [cited 2019 Oct 17];61:566-7. Available from: http://www.neurologyindia.com/text.asp?2013/61/5/566/121960


We describe an interesting imaging finding in two patients, one with chronic inflammatory demyelinating polyneuropathy (CIDP) and the other having neurofibromatosis. The trigeminal nerves were hypertrophied, giving the appearance of a moustache-'the moustache sign'.

Case 1

A 17-year-old girl presented with subacute, fluctuating, distal and proximal limb weakness, distal hypoesthesia, and generalized areflexia. Electrophysiology confirmed demyelination with multifocal conduction blocks at nonentrapment sites in all four limbs. Cerebrospinal fluid examination showed albumin-cytological dissociation. Magnetic resonance imaging (MRI) revealed bilateral thickening and enhancement of cisternal segment and all three divisions (ophthalmic, maxillary, and mandibular) of the trigeminal nerve [Figure 1]. Spinal roots were hypertrophied as well. Cranial nerve hypertrophy is seen in 11-57% patients with CIDP. [1]
Figure 1: Coronal short tau inversion recovery image showing trigeminal nerve in the Meckel's cave and its maxillary division as it exits foramen ovale. The nerve is thickened and giving the appearance of 'moustache'

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Case 2

A 30-year-old male presented with sensory ataxia, areflexia, distal weakness, and wasting of all four limbs. MRI showed multiple intraspinal schwannomas, meningiomas, ependymomas, and bilateral vestibular schwannomas. The trigeminal nerves were thickened [Figure 2].
Figure 2: T1 weighted magnetic resonance imaging with contrast showing enlargement of trigeminal nerves due to schwannomas giving the appearance of the 'moustache'

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Besides these two causes, trigeminal nerve may be enlarged in the following conditions: (1) Infections: Tuberculosis, syphilis, leprosy, mycoplasma, Lyme's disease; (2) immune mediated: Polyneuritis cranialis, chronic inflammatory demyelinating polyradiculoneuropathy, sarcoidosis, Wegener's granulomatosis, pachymeningitis, Tolosa Hunt syndrome; (3) neoplastic: Carcinoma, lymphoma/leukemia, myeloma, neurofibroma, schwannoma; (4) physical/toxins: Radiation, trauma, surgery, toxins; and (5) Hereditary: Hereditary neuropathies and leukodystrophies. [2]


  Acknowledgement Top


Department of Radiology, Bombay Hospital, Mumbai.

 
  References Top

1.Shah S, Chandrashekar H, Manji H, Davagnanam I. Image of the moment: Cranial nerve, spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Pract Neurol 2012;12:68-9.  Back to cited text no. 1
[PUBMED]    
2.Majoie CB, Verbeeten B Jr, Dol JA, Peeters FL. Trigeminal neuropathy: Evaluation with MR imaging. Radiographics 1995:4:795-811.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]

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