13.1.1.2.2 Trigeminal neuralgia attributed to spaceoccupying lesion

Identification: Male patient, 47 years old, with a history of progressive facial pain for 4 months. History of Present Illness: Pain: Location: Left V2 (maxillary) Characteristic: Paroxysms of "electric shock" (10-45 seconds) Intensity 9/10 Increasing frequency (5→30 episodes/day) Continuous component: Interictal burning sensation (4/10) in the malar region Associated symptoms: Progressive paresthesias in V2 Episodes of diplopia (2 weeks) Weight loss (6kg/4 months) Physical/Neurological Examination: Trigeminal assessment: Thermal and pain hypoesthesia in V2 "Shotgun" anesthesia on the upper lip Ipsilateral corneal reflex abolished Neurological signs: Ipsilateral sixth cranial nerve paresis Mild ataxia in the right upper limb Complementary Examinations: 3T MRI with contrast: Expansive lesion (3.2×2.8cm) in the left cerebellopontine angle Heterogeneous enhancement with mass effect on the brainstem Compression/extinction of the trigeminal root Stereotactic biopsy: Transitional meningioma (WHO Grade I) Systemic evaluation: PET-CT without metastases