MRI findings in trigeminal neuropathy: bilateral Meckel’s cave lesions

Excerpt

A 43-year-old woman presented during wintertime after a 2-day episode of acute facial pain in the ophthalmic (V1) division of the right trigeminal nerve, and numbness in both the right maxillary (V2) and mandibular (V3) divisions. Her history was remarkable for seronegative arthritis and bronchiolitis obliterans with organizing pneumonia (BOOP), though she was not on immunosuppressive therapy. Symptoms spontaneously resolved, and no focal findings were appreciated on neurological examination. CRP was 9.3 mg/L, ANA was positive at 1:160, and ACE level was within normal range. Magnetic resonance imaging (MRI) revealed an enhancing expansile mass within the right Meckel’s cave extending into the right foramen ovale (Fig. 1a, d). Computed tomography of the chest showed changes consistent with BOOP and new nodules measuring < 5 mm in size of undetermined etiology. Given that the patient was asymptomatic, she was monitored with surveillance MRI which was stable after 6 months. Repeat MRI of the brain a year after initial presentation showed resolution of the previously noted lesion within the right Meckel’s cave; however, an enhancing mass was surprisingly detected within the left Meckel’s cave (Fig. 1b, e). The patient denied to have symptoms at that time point and no treatment was administered. MRI of the brain 2 years after initial presentation demonstrated resolution of the left-sided enhancing mass with no evidence of residual lesions in both Meckel’s caves (Fig. 1c, f). Six years after initial presentation, she has remained clinically stable with no lesion recurrence. …