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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 5  |  Page : 540-541

Facial pain in carcinoma colon


Department of CT/MRI, ESIC Hospital, Mumbai, Maharashtra, India

Date of Submission17-Oct-2013
Date of Decision17-Oct-2013
Date of Acceptance24-Oct-2013
Date of Web Publication22-Nov-2013

Correspondence Address:
Prashant S Naphade
Department of CT/MRI, ESIC Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.121945

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How to cite this article:
Naphade PS, Keraliya AR. Facial pain in carcinoma colon. Neurol India 2013;61:540-1

How to cite this URL:
Naphade PS, Keraliya AR. Facial pain in carcinoma colon. Neurol India [serial online] 2013 [cited 2022 Jul 4];61:540-1. Available from: https://www.neurologyindia.com/text.asp?2013/61/5/540/121945


Sir,

A 26-year-male, operated case of adenocarcinoma transverse colon, presented with left facial pain and numbness. Clinical examination was revealed sensory deficit on the left side of face. Brain magnetic resonance imaging(s) revealed abnormal T2/fluid-attenuated inversion recovery hyperintense oval lesions causing diffuse enlargement of cisternal part of left trigeminal nerve [Figure 1]a and b, thick arrow] and both trigeminal ganglia in Meckel's cave [Figure 1]a and b, thin arrows]. Three dimensional-T2W-driven equilibrium radiofrequency reset pulse axial and sagittal oblique images excellently demonstrated the spread along trigeminal pathways [Figure 1]c-e. These lesions appear heterogeneously hypointense on pre-contrast T1-weighted images [Figure 2]a. Post-contrast scan shows homogenous enhancement of mass lesions as long cisternal part of left trigeminal nerve and both trigeminal ganglia [Figure 2]b-d. No extension was seen along the branches of trigeminal nerves. Brainstem revealed no focal lesion at the expected location of trigeminal nuclei. These findings are suggestive of bilateral trigeminal metastasis. This case illustrates the classic imaging findings in metastatic spread along central trigeminal pathways. Patient is being treated with palliative radiotherapy.
Figure 1: Axial T2 (a) and fluid-attenuated inversion recovery (b) images reveal hyperintense mass lesions causing diffuse enlargement of cisternal part of left trigeminal nerve (thick arrow) and both trigeminal ganglia (thin arrows). Driven equilibrium radiofrequency reset pulse (three dimensional-T2W-driven equilibrium radiofrequency reset pulse) axial (c), reformatted right (d) and left (e) sagittal oblique images excellently demonstrates spread along trigeminal pathways

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Figure 2: Pre-contrast T1 axial (a) reveals hypointense mass lesions along cisternal part of left trigeminal nerve and both trigeminal ganglia with homogenous enhancement on post-contrast T1 axial (b), reformatted right (c) and left (d) sagittal oblique images

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Malignant trigeminal neuropathy is commonly due to perineural spread along the branches of trigeminal nerve secondary to squamous cell carcinomas and adenoid cystic carcinomas in head and neck region. Trigeminal nerve metastasis is uncommon reported manifestation in breast cancer, melanoma and colon cancer. [1],[2] To the best of our knowledge; bilateral trigeminal metastasis with trigeminal ganglion involvement due to metastatic colon carcinoma is not reported.

 
  References Top

1.Mastronardi L, Lunardi P, Osman Farah J, Puzzilli F. Metastatic involvement of the Meckel's cave and trigeminal nerve. A case report. J Neurooncol 1997;32:87-90.  Back to cited text no. 1
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2.Hirota N, Fujimoto T, Takahashi M, Fukushima Y. Isolated trigeminal nerve metastases from breast cancer: An unusual cause of trigeminal mononeuropathy. Surg Neurol 1998;49:558-61.  Back to cited text no. 2
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