Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour

Abstract

A woman in her late 80s with severe bronchomalacia was referred to a tertiary orofacial pain clinic for unexplained right unilateral glossodynia of progressive and continuous evolution for the past 8 months, spreading to the ipsilateral labiomental region, associated with ipsilateral hypoacusia. Local and general clinical examinations were unremarkable and routine blood work could not reveal any underlying systemic disease explaining the glossodynia and burning/pricking labiomental pain. Suspecting a painful trigeminal neuropathy secondary to a space-occupying lesion, a cerebral MRI was prescribed, revealing an ipsilateral cerebellopontine angle lesion, compatible with either a schwannoma or meningioma. This lesion invaded the root entry zones of cranial nerves V and VIII explaining the patient’s oral pain and hypoacusia. Following a neurosurgical consultation where surgical treatment was rejected, her pain was successfully managed by topical pregabalin mouthwashes, to prevent any risk of respiratory depression related to her underlying severe bronchomalacia.

Close Your Eyes and See: Stroke Sequelae versus Functional Neurological Disorder in a Physician

“…Complications of posterior fossa surgery include injury to the cranial nuclei [ 10 ] and a lesion of the middle cerebellar peduncle may affect nearby cranial nerves [ 11 ]. In my case, right unilateral burning pain resulted from distortion of the right spinal trigeminal tract [ 12 ]. The pars oralis is the site where lingual pain fibers run and enter the spinal trigeminal tract.…”