Background and Overview
Trigeminal neuralgia due to a metastatic lesion is a relatively rare occurrence. These
cases pose a diagnostic challenge for the clinician due to a complex clinical presentation.
The authors describe the case of a 65-year-old woman with left-sided facial pain and
occasional numbness. The patient also reported autonomic features associated with
facial pain, facial muscular weakness, and hearing and visual impairment. The patient’s
history of breast cancer, for which she was receiving treatment for bone metastasis,
warranted diagnostic imaging. Magnetic resonance imaging with and without contrast
was performed and revealed a possible metastatic lesion.
Conclusions and Practical Implications
Unusual clinical features must be identified, and prompt appropriate imaging is instrumental
in making at an accurate diagnosis and management plan.
CN (Cranial nerve), IASP (International Association for the Study of Pain), MRI (Magnetic resonance imaging), TN (Trigeminal neuralgia)
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Trigeminal neuralgia: diagnosis and treatment.
Cephalalgia. 2017; 37: 648-657
Trigeminal neuralgia: new classification and diagnostic grading for practice and research.
Neurology. 2016; 87: 220-228
Prevalence of trigeminal neuralgia: a systematic review.
JADA. 2016; 147: 570-576 e2
AAN-EFNS guidelines on trigeminal neuralgia management.
Eur J Neurol. 2008; 15: 1013-1028
Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies.
Neurology. 2008; 71: 1183-1190
The IASP classification of chronic pain for ICD-11: chronic neuropathic pain.
Pain. 2019; 160: 53-59
The HDAC1/c-JUN complex is essential in the promotion of nerve injury-induced neuropathic pain through JNK signaling.
Eur J Pharmacol. 2018; 825: 99-106
IASP. Peripheral neuropathic pain. Last updated December 14, 2017. Accessed July 29, 2020. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Peripheralneuropathicpain
Comparison of the neuropathic pain symptoms and psychosocial impacts of trigeminal neuralgia and painful posttraumatic trigeminal neuropathy.
J Oral Facial Pain Headache. 2019; 33: 77-88
Trigeminal neuralgia: a prospective systematic study of clinical characteristics in 158 patients.
Headache. 2014; 54: 1574-1582
Pain of the trigeminal nerve as the first symptom of a metastasis from an oesohaguscarcinoma in Meckel’s cave: case report. Article in German..
Zentralbl Neurochir. 2001; 62: 65-68
Headache Classification Committee of the International Headache Society (IHS): the International Classification of Headache Disorders, 3rd ed.
Cephalalgia. 2018; 38: 1-211
Tic versus TAC: differentiating the neuralgias (trigeminal neuralgia) from the cephalalgias (SUNCT and SUNA).
Curr Pain Headache Rep. 2015; 19: 473
The importance of autonomic symptoms in trigeminal neuralgia. Clinical article.
J Neurosurg. 2011; 115: 210-216
Complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD).
Neuropathic orofacial pain: facts and fiction.
Cephalalgia. 2017; 37: 670-679
Numbness matters: a clinical review of trigeminal neuropathy.
Cephalalgia. 2011; 31: 1131-1144
Metastasis to the base of the skull: clinical findings in 43 patients.
Neurology. 1981; 31: 530-537
Secondary trigeminal neuralgia in cerebellopontine angle tumors.
Skull Base. 2011; 21: 287-294
Pterygopalatine fossa metastasis with severe trigeminal neuralgia from neuroendocrine carcinoma of the breast.
Auris Nasus Larynx. 2017; 44: 131-133
Cavernous sinus syndrome associated with metastatic colorectal cancer and perineural spread along the trigeminal nerve.
Am J Ophthalmol Case Rep. 2017; 6: 67-70
Metastatic renal cell carcinoma mimicking trigeminal schwannoma in a patient presenting with trigeminal neuralgia.
J Neurol Surg Rep. 2015; 76: e282-e286
Malignant lymphoma in a perineural spreading along trigeminal nerve, which developed as trigeminal neuralgia.
Rinsho Shinkeigaku. 2014; 54 (Article in Japanese): 660-663
Diffuse large B cell lymphoma presented as trigeminal neuralgia: 2 cases reported and literature review.
World Neurosurg. 2019; 123: 383-389
Trigeminal neuralgia caused by the metastasis of malignant lymphoma to the trigeminal nerve: a case report.
No Shinkei Geka. 1998; 26: 401-405
Central demyelination in the pathogenesis of trigeminal neuralgia associated with cerebellopontine angle tumors: case report with ultrastructural trigeminal root analysis.
Neurosurgery. 2010; 66: e841-e842
Trigeminal neuralgia caused by brain tumors; study of 125 cases.
Masui. 1988; 37: 1002-1006
Oral Dis. 2007; 13: 141-150
Idiopathic trigeminal neuropathy with trigeminal mass lesion on MRI: neoplasm or not?.
Cephalalgia. 2010; 30: 968-974
Neoplastic trigeminal neuropathy: presentation of 7 cases.
Med Oral Patol Oral Cir Bucal. 2006; 11: e106-e111
Dr. Thomas is an assistant professor, Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen St, Newark, NJ 07101-1709
Dr. Katzmann is a postgraduate resident, Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ.
Dr. Singer is the chair, Department of Diagnostic Sciences Director, Division of Oral and Maxillofacial Radiology, Rutgers School of Dental Medicine, Newark, NJ.
Dr. Pitchumani is a postgraduate resident, Department of Periodontology, Ohio State University College of Dentistry, Columbus, OH.
Dr. Kohli is a research teaching specialist V, Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ.
Published online: September 03, 2021
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Disclosures. None of the authors reported any disclosures.
© 2021 American Dental Association. All rights reserved.
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