Pearls & Oy-sters: Bilateral Neuropathic Facial Pain With Autonomic Features and Neurovascular Contact.
Vivian Ni, Kara-Marie Nedd
✦ AI-curated · Sources linked
Case in brief
A 35-year-old woman presented with severe bilateral facial pain in the V1 and V2 distributions, exacerbated by cosmetic product use and following a viral upper respiratory infection. The pain was accompanied by autonomic symptoms such as facial swelling and tearing. MRI revealed neurovascular contact with the trigeminal nerves but no demyelination. The patient found relief with carbamazepine and indomethacin, indicating a potential overlap with trigeminal autonomic cephalalgias.
What made this case unusual
The case is notable for the progression of trigeminal neuralgia to bilateral symmetric involvement with significant autonomic features, which is atypical for this condition.
Diagnostic / clinical pearl
Clinicians should consider the possibility of bilateral trigeminal neuralgia with autonomic features, especially following viral infections, and recognize the potential overlap with trigeminal autonomic cephalalgias.
Why it matters
This case highlights the importance of a comprehensive diagnostic approach in facial pain syndromes, as atypical presentations may require multifaceted treatment strategies.