19 yr old with ??trigeminal neuralgia

[weeblelady]

Please help, my 19 yr old last oct 2007 suddenly developed a purple rash on right side of face.  Her face felt tight and unable to move that side and her mouth on that side.  She had severe pain and a severe headache.  This lasted several days.  The local ER said it was an infection and gave here antibiotics.  The same thing happened again in Feb 08.  (she is a college student at RIT in NY).   This time the ER did a cat scan and then said it was trigeminal.  The condition continued once again for several days.  She was sent to an outside neuro Dr. there.  He initially said it couldn't be trigeminal because of her age.  Did an MRI said she didn't have a tumor so it must be trigeminal.  He put her on elavil.

Once again, the condition has happened again.  Her face started with feeling tight and stiff, then the strange purple rash and swelling, speech is affected can't move mouth on that side, headache.  The rash disappeared in 2 days but it took a few more before the rest of symptoms resolved.  Her mouth still has some assemetry on that side

I must also add  she has had 3 back surgeries s1-L5.  The 3rd fusion a year ago, is failing again, no bone growth.


I have taken pictures of the rash.  I posted it back in feb in the dermatology forum.

Does this sound like Trigeminal neuralgia?  From what we have read online, we aren''t so sure.  Any help or suggestions would be greatly appreciated.  It is very disabling and painful even though my daughter is a tough cookie!

[Michael Lim, MD]

In general, trigeminal neuralgia is a clinical diagnosis consisting of shooting pain that lasts seconds to minutes.  It usually occurs on one side of the face and can be triggered with stimuli such as a breeze, cold drinks, talking, facial expressions, and brushing teeth.  It is uncommon to see an associated purple rash.  Perhaps visiting her neurologist again may be a good next step.

[Michael Lim, MD]

While herpes zoster should certainly be considered, a detailed history and exam will help in making the diagnosis.

[helper11]

doesnt it sound like herpes zoster