(368) Atypical Facial Neuropathic Syndrome, Our Approach

Abstract

Atypical facial neuralgias are a rare condition, that present predominantly in the female population, with an annual incidence of 3-4 cases every 100 000 people. The trigeminal nerve root is mostly affected, and not commonly combined with autonomic symptoms. We are presenting a 59 years old, female patient, with significant medical history for anxiety, depression and autoimmune liver disease, on long term steroid treatment. She suddenly started complaining of severe periodic right facial pain about 15 years ago, after an sneezing episode, described as stabbing in quality and triggered by minor stimulus; also accompanied with hypoacusia, vertigo, tinnitus, dysgesia, rinorrhea and paresthesias in the ipsilateral upper extremity. All this limited her regular everyday functionality, affecting her role as a teacher. No significant findings in the physical exam. Laboratory studies and imaging did not reveal any pathology. Thermography imaging reported higher intensity imaging over right neck, right face, suggestive of myofascial pain component. She was followed by various medical specialties, receiving multimodal treatment, including anti depressives, analgesics, hearing aids, and acupuncture, with minor crisis relief. She was finally evaluated in our Pain Management Clinic with diagnosis of complex facial neuropathic pain. The patient was started on Pregabalin, progressively titrated to 100 mg every 12 hours, without significant side effects and with positive response after 3 months of treatment, reporting significant improvement of the pain, and partial recovery auditory function and almost absolute reversal of other autonomic symptoms.