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.
(A) Ulceration and destruction of left nasal ala. (B) T2-weighted axial image shows an area of hyperintensity over the left lateral medulla in the distribution of the spinal tract nucleus of the trigeminal nerve. (C) T2-weighted fluid-attenuated inversion recovery coronal image shows the longitudinal extent of the lesion within the medulla.
Author contributions
L.M.M., T.N.S.H., T.L.C., and N.S.C. performed the initial assessment and investigations of the patient. L.M.M., T.L.C., J.V., and N.S.C. helped in the compilation of the text, literature search, and editing of the manuscript.
Study funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides: links.lww.com/WNL/A35
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