Teaching NeuroImages: Facial ulceration in stroke

Abstract

A 50-year-old woman with a history of lateral medullary stroke 3 years ago presented with a 7-month history of persistent itch with constant picking and a nonhealing ulcer on the left side of her face (figure). Examination revealed anesthesia over the V2 distribution of the trigeminal nerve. Trigeminal trophic syndrome is a rare cause of chronic facial ulceration first described by Wallenberg.1 It results from damage to the trigeminal ganglion or nerve. Causes include trigeminal nerve ablation, stroke, tumors, herpes, and leprosy.2 The ulceration results from self-mutilation due to facial anesthesia and paresthesias.