Trigeminal neuralgia as a presenting symptom of brain metastasis in advanced stage of breast cancer

Abstract

Trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. We report a case of trigeminal neuralgia which was a presenting symptom for the diagnosis of brain metatstasis in a patient with advanced stage of breast cancer. A 51 old female complained of right facial pain. She had been diagnosed invasive ductal carcinoma one year ago. Since the detection of cancer, she had multiple metastasis in bone, both lung and chest wall. Brief recurrent lanscinating right facial pain was persisted during 7 days without relief. On admission, pain was distributed in maxillary and mandibular division of trigeminal nerve. Neurologic examination revealed no contraction of masseter and temporalis on the same side. Hypestheia was accompanied in right maxillary and mandibular branch of trigeminal nerve. Brain MRI depicted multiple metastasis in right cavernous sinus, Meckel’s cave and bilateral cerebellum. Neurophysiologic study showed normal blink reflex response, but no potential for masseter reflex test. She was diagnosed with secondary trigeminal neuralgia and we prescribed oxcarbazepine with palliative chemotherapy. Malignant metastasis involving the path of trigeminal nerve could elicit neuralgic pain as a secondary cause of trigeminal neuralgia. In our patient, the neuralgic pain in the area of trigeminal nerve was the only presenting symptom of brain metastasis. Secondary cause of trigeminal neuralgia should be evaluated with extensive brain imaging especially in patient with cancer.