Gasserian Ganglion Syndromes

Numerous pathological processes occurring within the middle cranial fossa can result in trigeminal dysfunction by affecting the gasserian ganglion. In children, osteitis of the petrous apex following suppurative otitis media or mastoiditis, which leads to inflammation and infection affecting the trigeminal ganglion, may result in Gradenigo's syndrome. The syndrome is characterized by facial pain, headache, or sensory loss and a sixth cranial nerve palsy, facial palsy (due to seventh nerve involvement), and deafness (due to eighth nerve involvement). The pain is described as boring or throbbing, worse at night. Pain is aggravated by jaw or ear movement. It has been hypothesized that some of the dysesthetic sensation patients experience before or during episodes of Bell's palsy may reflect involvement of the trigeminal ganglion or nuclei in the brain stem. y A benign, self-limited trigeminal sensory neuropathy has been reported in children 7 to 21 days following a nonspecific febrile illness or upper respiratory infection. y Like other postinfectious cranial neuropathies involving the abducens, glossopharyngeal, or hypoglossal nerves, laboratory evaluations are normal or show only a mild CSF pleocytosis. Symptoms resolve usually within 1 to 2 months. It is unknown whether these postinfectious neuropathies result from peripheral nerve, ganglion, or brain stem pathology.

Trigeminal sensory neuropathy may occur in association with connective tissue disorders such as mixed connective tissues disease, systemic sclerosis, Sjogren's syndrome, and systemic lupus erythematosus.1:ยป] , y Symptoms including facial dysesthesias, numbness, and loss of taste may be the presenting complaints. y In such cases, based on radiographical and electrophysiological testing, involvement of the gasserian ganglion is likely. Various infectious processes within the middle cranial fossa including syphilis, tuberculosis, and bacterial meningitis can affect the gasserian ganglion by inflammation, ischemia, or direct compression. Similarly, neoplasms in this region (meningiomas, schwannomas) can compress the ganglion within Meckel's cave.

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