Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of acute autonomic, sensory and motor neuropathy with swelling and gadolinium enhancement of bilateral trigeminal nerve on MRI and dissociation between superficial and deep sensation disturbance

Hiroyuki Naito, M.D.1), Hikaru Doi, M.D.1), Saeko Inamizu, M.D.1), Hijiri Ito, M.D.2) and Takehisa Araki, M.D.1)

1)Department of Neurology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital
2)Hananosato, Miyoshi Neurology Clinic

We report a case of a 46-year old man with acute autonomic, sensory and motor neuropathy (AASMN). He developed severe orthostatic hypotension, anuria, anhydrosis, tonic pupil with dysarthria, dysphagia, jaw claudication, and dysesthesia and sharp pain several days after symptom of upper respiratory infection. Neurological examination revealed severely decreased superficial sensation with normal deep sensation. Brain MRI findings showed bilateral trigeminal nerve swelling with gadolinium (Gd) enhancement. His motor and sensory symptoms and MRI abnormality were improved after the administration of intravenous immunoglobulin and intravenous methylprednisolone therapy; however his autonomic symptoms scarcely reacted to these immunotherapies. As long as we investigated in AASMN cases, bilateral trigeminal nerve swelling with Gd enhancement and dissociation between superficial and deep sensation disturbance have not reported, suggesting that the present case mainly disrupted C nerve fibers distributing postganglionic autonomic and temperature-pain sensory nerves.
Full Text of this Article in Japanese PDF (2231K)

(CLINICA NEUROL, 53: 125|130, 2013)
key words: acute autonomic, sensory and motor neuropathy (AASMN), dysautonomia, orthostatic hypotension, trigeminal nerve

(Received: 30-Apr-12)