DR Medhat MRCP

• Trigeminal nerve palsy:
o Causes (from the origin outwards) :
‣ Central causes (lesion in pons ,medulla, upper cervical cord)
1. Tumour.
2. Syringobulbia (fluid-filled tubular cyst in cervical cord&brainstem)
3. Vascular e.g stroke
4. Herpes zoster
‣ Lesion in trigeminal ganglion:
هام tumour) 1. Acaustic neuroma (ponto-cerebellar angle
2. Meningioma
3. Fracture middle fossa.
‣ Lesion in the cavernous sinus (ophthalmic & maxillary division) :
1. Tumour.
2. Aneurysm.
3. Thrombosis
‣ Peripheral nerve causes :
1. Tumour.
2. Aneurysm
o Clinical picture :
A. Sensory affection :
- Peripheral lesion : loss of sensations on the same side of
the face(except angle of the mandible)including all face or
areas supplied by the affected branch.
- Central lesion :
Sensory loss according to the affected nucleus
B. Motor affection :
- Weakness of ms of mastication on the same side of lesion.
- Deviation of the jaw to the affected side (due to
unopposed action of pterygoid muscles of healthy side.
C. Reflex affection :
- Ipsilateral loss of corneal & conjunctival reflexes (aff 5 &
eff 7).
- Ipsilateral loss of palatal reflex (aff 5& eff 10).
- Exaggerated jaw reflex (aff 5 & eff 5).
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