13.1.2.5 Idiopathic painful trigeminal neuropathy

Identification: Female patient, 58 years old, with chronic facial pain for 14 months, without a history of trauma or systemic comorbidities.

History of Present Illness:
Symptoms:
Location: Left V2 (maxillary)

Characteristics:
Continuous pain: Deep pressure (5-7/10 VAS)
Exacerbations: Stabbing (8/10), 3-8 episodes/day

Sensory phenomena:
Intermittent tingling paresthesias
Allodynia with the use of glasses

Course:
Slow and continuous progression
No remission periods

Relevant History:
Negative for diabetes, hypertension, or autoimmune diseases
No history of facial surgeries or herpes infections

Physical/Neurological Examination:
Trigeminal Assessment:
Sensory:
Mild hypoesthesia to fine touch on the upper lip
Hyperpathy to percussion of the infraorbital foramen
Motor:
Masseter reflex preserved

General Examination:
Absence of skin or mucosal lesions
No systemic signs

Complementary Exams:
3T MRI with contrast:
Normal course of the infraorbital nerve
Absence of vascular compression or expansive lesions

Electroneuromyography:
Normal conduction velocity in the mental nerve
Preserved sensory potentials

Diagnostic Exclusion:
Normal blood glucose/HbA1c
Negative serologies for syphilis/Lyme