What Is Your Diagnosis? Eur Neurol 2013;70:331–332 DOI: 10.1159/000353189
Received: April 23, 2013 Accepted: May 19, 2013 Published online: October 15, 2013
Numb Cheek Syndrome: A Clinical-Anatomical Correlation Xuling Lin Kim En Lee Department of Neurology, National Neuroscience Institute, Singapore
A previously healthy 81-year-old lady presented with isolated right cheek numbness. She had no systemic symptoms. Neurological examination revealed a hypoesthetic area on her left cheek. Figure 1 shows her brain MRI. What is your diagnosis?
Fig. 1. T2 hyperintense mass in the right anterior aspect of the in-
© 2013 S. Karger AG, Basel 0014–3022/13/0706–0331$38.00/0 E-Mail [email protected] www.karger.com/ene
Dr. Xuling Lin, MRCP (UK) Department of Neurology, National Neuroscience Institute 11 Jalan Tan Tock Seng Singapore 308433 (Singapore) E-Mail xuling_lin @ nni.com.sg
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ferior cavernous sinus region extending into the right foramen rotundum (dotted arrow).
Diagnosis: Trigeminal Schwannoma
The sensory component of the trigeminal nerve has three divisions: ophthalmic (passes through the superior orbital fissure), maxillary (foramen rotundum) and mandibular (foramen ovale). Numb cheek syndrome secondary to tumor or arterial compression, perineural infiltration [1] and anti-Hu paraneoplastic neuronopathy [2] have been described. In this case, MRI demonstrated a peripherally enhancing lobulated hyperintense mass in the right anterior aspect of the inferior cavernous sinus region, extending inferiorly into the right foramen rotundum (fig. 1). A CT scan (not shown) showed bony remodeling in the adjacent area with no body destruction. Appearances suggest a benign, long-standing tumor. A follow-up scan shows the lesion marginally smaller with susceptibility and homogeneous enhancement (fig. 2), consistent with interval intratumoral hemorrhage of a trigeminal schwannoma.
Key Words Brain tumor · MRI · Neuroanatomy · Neuroimaging · Neuropathy Fig. 2. A follow-up MRI scan at 3 months, showing the right cav-
ernous sinus lesion with susceptibility and homogeneous enhancement (arrowhead), suggesting interval intratumoral hemorrhage, a rare complication in trigeminal schwannomas.
332
1 Clouston PD, Sharpe DM, Corbett AJ, Kos S, Kennedy PJ: Perineural spread of cutaneous head and neck cancer: its orbital and central neurologic complications. Arch Neurol 1990; 47:73.
Eur Neurol 2013;70:331–332 DOI: 10.1159/000353189
2 Raaphorst J, Vanneste J: Numb cheek syndrome as the first manifestation of anti-Hu paraneoplastic neuronopathy. J Neurol 2006; 253:664–665.
Lin/Lee
Downloaded by: University of Pennsylvania 130.91.193.202 - 1/6/2014 5:17:42 PM
References
Received: April 23, 2013 Accepted: May 19, 2013 Published online: October 15, 2013
Numb Cheek Syndrome: A Clinical-Anatomical Correlation Xuling Lin Kim En Lee Department of Neurology, National Neuroscience Institute, Singapore
A previously healthy 81-year-old lady presented with isolated right cheek numbness. She had no systemic symptoms. Neurological examination revealed a hypoesthetic area on her left cheek. Figure 1 shows her brain MRI. What is your diagnosis?
Fig. 1. T2 hyperintense mass in the right anterior aspect of the in-
© 2013 S. Karger AG, Basel 0014–3022/13/0706–0331$38.00/0 E-Mail [email protected] www.karger.com/ene
Dr. Xuling Lin, MRCP (UK) Department of Neurology, National Neuroscience Institute 11 Jalan Tan Tock Seng Singapore 308433 (Singapore) E-Mail xuling_lin @ nni.com.sg
Downloaded by: University of Pennsylvania 130.91.193.202 - 1/6/2014 5:17:42 PM
ferior cavernous sinus region extending into the right foramen rotundum (dotted arrow).
Diagnosis: Trigeminal Schwannoma
The sensory component of the trigeminal nerve has three divisions: ophthalmic (passes through the superior orbital fissure), maxillary (foramen rotundum) and mandibular (foramen ovale). Numb cheek syndrome secondary to tumor or arterial compression, perineural infiltration [1] and anti-Hu paraneoplastic neuronopathy [2] have been described. In this case, MRI demonstrated a peripherally enhancing lobulated hyperintense mass in the right anterior aspect of the inferior cavernous sinus region, extending inferiorly into the right foramen rotundum (fig. 1). A CT scan (not shown) showed bony remodeling in the adjacent area with no body destruction. Appearances suggest a benign, long-standing tumor. A follow-up scan shows the lesion marginally smaller with susceptibility and homogeneous enhancement (fig. 2), consistent with interval intratumoral hemorrhage of a trigeminal schwannoma.
Key Words Brain tumor · MRI · Neuroanatomy · Neuroimaging · Neuropathy Fig. 2. A follow-up MRI scan at 3 months, showing the right cav-
ernous sinus lesion with susceptibility and homogeneous enhancement (arrowhead), suggesting interval intratumoral hemorrhage, a rare complication in trigeminal schwannomas.
332
1 Clouston PD, Sharpe DM, Corbett AJ, Kos S, Kennedy PJ: Perineural spread of cutaneous head and neck cancer: its orbital and central neurologic complications. Arch Neurol 1990; 47:73.
Eur Neurol 2013;70:331–332 DOI: 10.1159/000353189
2 Raaphorst J, Vanneste J: Numb cheek syndrome as the first manifestation of anti-Hu paraneoplastic neuronopathy. J Neurol 2006; 253:664–665.
Lin/Lee
Downloaded by: University of Pennsylvania 130.91.193.202 - 1/6/2014 5:17:42 PM
References
