2023 American Academy of Neurology Abstract Website

Objective:

To describe an unusual localization for ‘ophthalmic nerve pattern’ of sensory loss and to review neuro-anatomic pathways of facial sensation.

Background:

Isolated ophthalmic nerve sensory loss is usually due to lesions in the ophthalmic nerve. Imaging of cervical spinal cord is not undertaken in patients with this finding even though spinal trigeminal nucleus (STN), which receives fibers that convey pain, temperature and light touch from the face and mucus membranes, extends from caudal pons to third/fourth cervical spinal cord level.

Design/Methods:

Case report.

Results:

A 54-year-old female with mild multiple sclerosis (MS) on no disease-modifying therapy (DMT), developed numbness and itching on her right scalp, radiating down her upper face. Neurologic exam revealed decreased sensation to light touch and pinprick in the distribution of the right ophthalmic branch (V1) and absent right corneal reflex. Vision, other facial sensation, cranial nerves and other neurologic functions were intact. Magnetic resonance imaging (MRI) of the brain revealed old demyelinating lesions and a new Gd-enhancing lesion in the right side of the upper cervical cord, corresponding to the pars caudalis portion of the spinal trigeminal nucleus. She received gabapentin for pain, which was tapered as her symptoms resolved within weeks.

Conclusions:

Our patient appeared to have a lesion within the ophthalmic nerve, but her deficits were due to demyelination in pars caudalis of STN in cervical spine. Localized loss of sensation in our patient is likely due to somatotopic organization of STN whereby the midline facial structures are represented rostrally and the caudal portion – laterally (‘onionskin’ pattern). Patients presenting with unexplained ophthalmic nerve pattern of sensory loss may require dedicated imaging of cervical cord.