A Case of Trigeminal Neuropathy due to an Organic Brain Disease Which Was Difficult to Diagnose According to His Psychosocial Stressor

Abstract

Patient: The patient was a male in his mid-40s. He had been suffering from lingual hypesthesia on the right side with a burning sensation for 2 months. He visited our liaison outpatient clinic which perform team medicine by dentists and psychiatrists. According to the letter of referral, his previous oral and maxillofacial surgeon decided to refer him to our liaison outpatient clinic since the CT imaging did not show any abnormality, and he was under strong psychosocial stress. Our team performed MRI to reconsider the possibility of trigeminal neuropathy due to an organic disease, as the patient has continued to complain of his oral symptom even after his psychosocial stress relieved and the sign of depressive mood ameliorated subsequently. The MRI image pointed out some sort of cerebral abnormal lesion which could cause trigeminal neuropathy. Thus the team referred him to the neurology physicians, which turned out as trigeminal neuropathy presenting right trigeminal hypesthesia and dysesthesia caused by some organic lesion in the brain. Although the oligoclonal band was negative, the possibility of multiple sclerosis was undeniable according to the clinical presentation of spatial and temporal frequency. Therefore, careful follow up by the department of neurology is continued.
Discussion : Pain and hypesthesia are subjective complaints. Therefore, information obtained by medical interviews and appropriate examinations are particularly important for the diagnosis. This case was difficult to diagnose as strong psychosocial stress was apparent. However, performing head MRI by our clinic leaded to the discovery of organic disease in the brain.
Conclusions : This was a case first diagnosed as burning tongue caused by psychosocial stressor, but later diagnosed as some organic disease in the brain by collaboration and discussion by dentists and psychiatrists. We regarded this case as a valuable suggestive case in everyday clinical practice.