A Rare Case of Painful XXXX Secondary to Lateral Medullary Infarct: Neuroimaging and Electrophysiological Studies.

@entity1 @entity1183 @entity64 @entity2682 @entity16 @entity2850 @entity51 @entity1188 @entity158 @entity10 @entity9 @entity2055 @entity385
PURPOSE: To report a rare case of painful @entity16 after lateral medullary @entity1188 and probe its underlying pathogenesis on the basis of neuroimaging and electrophysiological study. CASE REPORT: A 45-year-old @entity1 presented acute onset of unsteady gait followed by paroxysmal and @entity10 in the distribution of ophthalmic branch of left trigeminal nerve in 2 days. Neurological examinations showed @entity1183 in the distribution of mandibular branch of left trigeminal nerve and @entity2055 . Muscle powers and deep tendon reflexes were normal. Brain magnetic resonance imaging revealed @entity1188 within the left cerebellum and middle portion of dorsolateral medulla. @entity2850 at the root entry zone of trigeminal nerve was excluded. Painful @entity16 secondary to lateral medullary @entity1188 was diagnosed. Ancillary blink reflex study 3 days after the @entity64 event showed abnormal late responses (R2), either ipsilateral or contralateral, after stimulation of left supraorbital nerve, suggesting left medullary lesion. Followup study 3 weeks later demonstrated normalization in absolute latencies of bilateral late responses, in line with remission of @entity158 paroxysms on low-dose @entity2682 treatment. CONCLUSION: Painful @entity16 attributed to lateral medullary @entity1188 is a unique disease entity. Ophthalmic branch involvement, coexisting @entity51 , absence of triggers, and rapid evolvement and remission are its characteristics. Our neuroimaging study delineated @entity385 pathology within descending tract and spinal nucleus of trigeminal nerve. Serial electrophysiological studies provide evidences supporting ephaptic transmission as the main pathogenesis concordant with dynamics of @entity9 and therapeutic implications.
