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Our patient fulfilled ICHD-2 criteria for symptomatic trigeminal neuralgia [5] and ICHD-3 criteria for painful trigeminal neuropathy attributed to a multiple sclerosis plaque [2].
We report the case of a 49-year-old woman with painful trigeminal neuropathy in the right maxillary division attributed to a multiple sclerosis plaque as the presenting symptom of multiple sclerosis.
This is to our knowledge the first detailed report of a case with an exacerbation of symptomatic trigeminal neuralgia in parallel to the onset of an immunomodulatory treatment for MS. Painful trigeminal neuropathy attributed to a multiple sclerosis plaque is defined by ICHD-3 beta criteria as pain clinically similar to classical trigeminal neuralgia [2].
The largest previously reported multiple sclerosis plaque measured 7.2 cm, a size determined by CT scan (Hershey et al., 1979).
In contrast to EBV+ lymphoma tissue, EBER1-positive multiple sclerosis plaque contained no additional EBV-specific transcripts such as EBNA2, LMP1 and BFRF-1, consistent with latency stage 0 of EBV infection.
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Multiple sclerosis plaques contained the same HML6 RNA concentration as control tissue.
In the sagittal view, multiple sclerosis plaques with an increased number of Dawson's fingers are noted (black arrow).
In the sagittal view, multiple sclerosis plaques with a typical perpendicular orientation at the callososeptal interface are noted (Dawson's fingers) (black arrow).
Only patients with classic TN (idiopathic) without any obvious pathology such as multiple sclerosis, plaques, tumors, and abnormalities of the skull base were considered in our study.
Solitary multiple sclerosis plaques thus remain a rare, but important differential diagnosis of malignant glioma.
Generally, multiple sclerosis plaques range from 3 to 16 mm in size.
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