Marginal Zone B-cell Lymphoma of the Gasserian Ganglion: Case Report and Review of the Literature / Linfoma de células B da zona marginal do gânglio de Gasser: Relato de caso e revisão da literatura

Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin's lymphoma that accounts for 4% of newly diagnosed central nervous system (CNS) tumors. Most primary lymphomas of the central nervous system are of the subtype of diffuse large B-cell lymphomas, which have highly aggressive behavior and may involve the brain, leptomeninges, eyes or spinal cord without evidence of systemic disease. Primary CNS lymphomas are very rare in immunocompetent patients, but their rates are increasing. So far, only 11 primary Gasser ganglion lymphomas have been reported, with an incidence of 2.5 cases per 30,000,000 inhabitants. However, B cell lymphomas of the marginal zone of the Gasserian ganglion have been very rarely reported. We report here a clinical presentation characteristic of B cell lymphoma of the marginal zone of the Gasser ganglion in an immunocompetent patient who was treated with surgery and radiotherapy, evolving with improvement of symptoms and without recurrence in 3 months of follow-up.

O linfoma primário do sistema nervoso central (PCNSL, na sigla em inglês) é um subtipo raro de linfoma não-Hodgkin extranodal que representa 4% dos tumores recém-diagnosticados do sistema nervoso central (SNC). A maioria dos linfomas primários do sistema nervoso central é do subtipo dos linfomas difusos de grandes células B, que tem comportamento altamente agressivo e pode envolver cérebro, as leptomeninges, os olhos ou a medula espinhal sem evidências de doença sistêmica. Os linfomas primários do SNC são muito raros em pacientes imunocompetentes, mas suas taxas estão aumentando. Até o momento, apenas 11 linfomas primários do gânglio de Gasser foram relatados, com uma incidência de 2,5 casos por 30.000.000 de habitantes. No entanto, linfomas de células B da zona marginal do gânglio de Gasserian foram muito raramente relatados. Relatamos aqui uma apresentação clínica característica de um linfoma de células B da zona marginal do gânglio de Gasser em um paciente imunocompetente que foi tratado com cirurgia e radioterapia, evoluindo com melhora dos sintomas e sem recorrência em três meses de acompanhamento.

Pulsed radiofrequency of superior cervical ganglion for treatment of painful post-traumatic trigeminal neuropathy (PTTN): A case series report.

Objective: Painful post-traumatic trigeminal neuropathy (PTTN) is a clinical pain syndrome that occurs due to injuries to the peripheral branches of the trigeminal nerve and is characterized by a deep burning pain and accompanied by positive and negative neurological signs. In patients with recalcitrant PTTN, the sympathetic nervous system is a potential therapeutic target. The aim of this study was to investigate the therapeutic response of PTTN patients to pulsed radiofrequency treatment (PRF) of the superior cervical sympathetic ganglion (SCG).Methods: Thirty-five patients with PTTN who had a history of severe disabling facial neuropathic pain underwent PRF of the SCG under a new lateral fluoroscopic approach.Results: The patients' pain intensity post-PRF was 3.94 (± 3.11), compared with 8.82 (± 1.27) pre-PRF (p < 0.001).Conclusion: PRF of the SCG could be an effective method to treat chronic PTTN.

Neurite idiopática do nervo trigêmeo em um cão / Idiopathic neuritis of the trigeminal nerve in a dog

Background: Idiopathic trigeminal neuropathy is a peripheral neuropathy whose clinical signs include inability to close themouth. A neurological examination reveals mainly flaccid paralysis of the masticatory muscles, which may be accompaniedby atony/hypotonia of the masseter and temporalis muscles. Altered sensitivity may also be present in very rare cases.This article reports a case of idiopathic trigeminal neuropathy with involvement of the motor and sensory nerve fibers in adog, describing the clinical symptoms, neurological findings, exclusion of other diseases, and evolution of the condition.Case: A 5-year-old bitch showing signs of difficulty in picking up food, swallowing water, and hypersalivation was takento a veterinary clinic. According to her owner, these signs had started spontaneously 2 days earlier. A physical examinationof the animal revealed only a persistently open mouth, although the mouth opening and closing movements could be performed manually by manipulating the jaw. The patient showed swallowing ability, and her tongue movements were intact.The neurological examination revealed that the animal also presented bilateral absence of nasal sensitivity and absenceof palpebral reflex. The animals blood test results showed changes only in the CK and AST levels, which were 1,182.60U/L (reference: 1.5 to 28.4 U/L) and 87.1 IU/L (reference: 6.2 to 13 IU/L), respectively. The animal tested negative fordistemper, leishmaniasis, toxoplasmosis and neosporosis. Abdominal ultrasound and thoracic radiography were performedto investigate neoplasia, as well as radiography of the temporomandibular joints, and none of these imaging tests revealedany alterations. A cerebrospinal fluid (CSF) analysis was also within the normal range of reference parameters. In view ofthe possibility of idiopathic trigeminal neuropathy, prednisolone...(AU)

Neurite idiopática do nervo trigêmeo em um cão / Idiopathic neuritis of the trigeminal nerve in a dog

Background: Idiopathic trigeminal neuropathy is a peripheral neuropathy whose clinical signs include inability to close themouth. A neurological examination reveals mainly flaccid paralysis of the masticatory muscles, which may be accompaniedby atony/hypotonia of the masseter and temporalis muscles. Altered sensitivity may also be present in very rare cases.This article reports a case of idiopathic trigeminal neuropathy with involvement of the motor and sensory nerve fibers in adog, describing the clinical symptoms, neurological findings, exclusion of other diseases, and evolution of the condition.Case: A 5-year-old bitch showing signs of difficulty in picking up food, swallowing water, and hypersalivation was takento a veterinary clinic. According to her owner, these signs had started spontaneously 2 days earlier. A physical examinationof the animal revealed only a persistently open mouth, although the mouth opening and closing movements could be performed manually by manipulating the jaw. The patient showed swallowing ability, and her tongue movements were intact.The neurological examination revealed that the animal also presented bilateral absence of nasal sensitivity and absenceof palpebral reflex. The animal’s blood test results showed changes only in the CK and AST levels, which were 1,182.60U/L (reference: 1.5 to 28.4 U/L) and 87.1 IU/L (reference: 6.2 to 13 IU/L), respectively. The animal tested negative fordistemper, leishmaniasis, toxoplasmosis and neosporosis. Abdominal ultrasound and thoracic radiography were performedto investigate neoplasia, as well as radiography of the temporomandibular joints, and none of these imaging tests revealedany alterations. A cerebrospinal fluid (CSF) analysis was also within the normal range of reference parameters. In view ofthe possibility of idiopathic trigeminal neuropathy, prednisolone...

Botulinum toxin-A injections as therapy for chronic painful post-traumatic trigeminal neuropathy: case report / Injeções de toxina botulínica-A como terapia para dor neuropática trigeminal pós-traumática crônica: relato de caso

Painful post-traumatic trigeminal neuropathy (PTTN) involves spontaneous and evoked pain, of moderate to severe intensity, continuous and described as burning or shooting. The first line treatment is pharmacological. However, botulinum toxin - A (BoNT-A) can be used when medications cannot control pain. This article describes the use of BoNT-A in a case of PTTN refractory to conventional pharmacological treatment. A 44-year-old male patient presented with an 8-years history of pain in the lower left second molar region. Pain was burning, lasting for seconds, with multiple pain episodes per day. Diagnosis hypothesis was PTTN. After no improvement with conventional pharmacological treatment, injections of BoNT-A were elected. Somatosensory assessment showed a significant reduction in visual analog scale for touch, cold and pinprick sensitivity. Likewise, patient's impression of change in pain significantly improved after BoNT-A injections. Our results suggest that BoNT-A could be used as a treatment for PTTN refractory to conventional treatments. (AU)

A neuropatia trigeminal pós-traumática dolorosa (PTTN) envolve dor espontânea e evocada, de intensidade moderada a grave, contínua e descrita como queimante ou lascinante. O tratamento de primeira linha é farmacológico. No entanto, a toxina botulínica - A (BoNT-A) pode ser usada quando os medicamentos não conseguem controlar a dor. Este artigo descreve o uso da BoNT-A em um caso de PTTN refratário ao tratamento farmacológico convencional. Paciente de sexo masculino, 44 anos, com 8 anos de dor na região do segundo molar inferior esquerdo. A dor foi descrita como queimante, com duração de segundos e com vários episódios por dia. A hipótese de diagnóstico foi PTTN. Após nenhuma melhora com o tratamento farmacológico convencional, as injeções de BoNT-A foram eleitas. A avaliação somatossensorial mostrou uma redução significativa na escala visual analógica para sensibilidade ao toque, frio e picada após BoNT-A. Da mesma forma, a impressão de mudança do paciente na dor melhorou significativamente após as injeções de BoNT-A. Nossos resultados sugerem que o BoNT-A poderia ser usada como tratamento para PTTN refratário a tratamentos convencionais. (AU)

Unilateral idiopathic sensory trigeminal nerve paralysis in a dog

Background: A spayed-female mixed breed dog was presented due to 2 years reduced visual acuity in the left eye. The investigation revealed corneal melanosis, keratoconjunctivis sicca and loss of facial sensation in the same side. The aim of this report is to describe an unilateral idiopathic sensory trigeminal nerve paralysis and keratitis as consequence of corneal innervation loss was established. Unilateral sensory trigeminal nerve paralysis is a very rare lesion in dogs and causes are unclear. Case: A 5-year-old spayed-female mixed breed dog was presented with a history of two years reduced visual acuity in the left eye. The Schirmer tear test values (without use of topical anesthetic) were 11 and 17 mm/min in the left and right eye respectively. Fluorescein tests were negative for both eyes. All postural reactions and spinal reflexes were normal. Cranial nerve evaluation identified symmetrical facial muscles (temporalis, masseter), indicating no muscle atrophy and normal motor nucleus of the fifth nerve. Absent sensation at the upper and lower lips margins, cornea, eyelids (medial and lateral canthi) and sensation in left nasal side were noted. No palpebral reflex was noticed, but there was spontaneous blinking of eyelids, which indicated normal facial nerve function. All other cranial nerve reflexes including menace response, oculocephalic, and gag reflexes were normal. The owner declined further workup, including cerebrospinal fluid analysis and images studies. According to the clinical presentation and neurological findings, presumptive diagnosis of unilateral idiopathic sensory trigeminal nerve paralysis was established. The dog was observed over 18 months without any clinical improvement. The Schirmer tear test showed same values (12 mm/min) and the melanosis remained unchanged.Discussion: Lesions that affected trigeminal nerve, trigeminal ganglion, or trigeminal tract in the pons and medulla caused facial hypoalgesia or analgesia...(AU)

Unilateral idiopathic sensory trigeminal nerve paralysis in a dog

Background: A spayed-female mixed breed dog was presented due to 2 years reduced visual acuity in the left eye. The investigation revealed corneal melanosis, keratoconjunctivis sicca and loss of facial sensation in the same side. The aim of this report is to describe an unilateral idiopathic sensory trigeminal nerve paralysis and keratitis as consequence of corneal innervation loss was established. Unilateral sensory trigeminal nerve paralysis is a very rare lesion in dogs and causes are unclear. Case: A 5-year-old spayed-female mixed breed dog was presented with a history of two years reduced visual acuity in the left eye. The Schirmer tear test values (without use of topical anesthetic) were 11 and 17 mm/min in the left and right eye respectively. Fluorescein tests were negative for both eyes. All postural reactions and spinal reflexes were normal. Cranial nerve evaluation identified symmetrical facial muscles (temporalis, masseter), indicating no muscle atrophy and normal motor nucleus of the fifth nerve. Absent sensation at the upper and lower lips margins, cornea, eyelids (medial and lateral canthi) and sensation in left nasal side were noted. No palpebral reflex was noticed, but there was spontaneous blinking of eyelids, which indicated normal facial nerve function. All other cranial nerve reflexes including menace response, oculocephalic, and gag reflexes were normal. The owner declined further workup, including cerebrospinal fluid analysis and images studies. According to the clinical presentation and neurological findings, presumptive diagnosis of unilateral idiopathic sensory trigeminal nerve paralysis was established. The dog was observed over 18 months without any clinical improvement. The Schirmer tear test showed same values (12 mm/min) and the melanosis remained unchanged.Discussion: Lesions that affected trigeminal nerve, trigeminal ganglion, or trigeminal tract in the pons and medulla caused facial hypoalgesia or analgesia...