Fawad A Khan1,2,3, Rinu Manacheril1, Robin Ulep2, Julie E Martin4, Anil Chimakurthy1. 1. The McCasland Family Comprehensive Headache Center, Department of Neurology, Ochsner Clinic Foundation, New Orleans, LA. 2. The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. 3. Tulane University School of Medicine, New Orleans, LA. 4. Department of Dermatology, Ochsner Clinic Foundation, New Orleans, LA.
Abstract
BACKGROUND: Trigeminal trophic syndrome (TTS) is an uncommon disorder of the trigeminal nerve tract and trigeminal brainstem nucleus. The syndrome is characterized by a triad of unilateral crescentic ulcers with anesthesia and paresthesias of the involved trigeminal dermatomes. CASE REPORT: A 24-year-old right-handed black female presented to our emergency department with a 4-week history of rapidly progressive painless desquamation/denudation of skin over her right face and scalp. Four weeks prior, she had been admitted to another institution for seizures and was diagnosed with seizures provoked by synthetic marijuana use. She was afebrile during her initial presentation at our institution. Dermatologic examination revealed denudation of the epidermis and partial dermis over the right frontal, parietal, and temporal scalp with associated alopecia. CONCLUSION: To our knowledge, the association of disorders of the trigeminal nerve pathway, including TTS, with the use of synthetic marijuana has not been previously reported. The long-term neurologic effects of synthetic marijuana are difficult to predict, and the pathologic underpinnings of TTS are largely unknown. Further studies dedicated to exploring the underlying molecular and cellular mechanisms may translate into effective therapies and approaches to halt and reverse the process and prevent tissue destruction and cosmetic disfigurement.
BACKGROUND:Trigeminal trophic syndrome (TTS) is an uncommon disorder of the trigeminal nerve tract and trigeminal brainstem nucleus. The syndrome is characterized by a triad of unilateral crescentic ulcers with anesthesia and paresthesias of the involved trigeminal dermatomes. CASE REPORT: A 24-year-old right-handed black female presented to our emergency department with a 4-week history of rapidly progressive painless desquamation/denudation of skin over her right face and scalp. Four weeks prior, she had been admitted to another institution for seizures and was diagnosed with seizures provoked by synthetic marijuana use. She was afebrile during her initial presentation at our institution. Dermatologic examination revealed denudation of the epidermis and partial dermis over the right frontal, parietal, and temporal scalp with associated alopecia. CONCLUSION: To our knowledge, the association of disorders of the trigeminal nerve pathway, including TTS, with the use of synthetic marijuana has not been previously reported. The long-term neurologic effects of synthetic marijuana are difficult to predict, and the pathologic underpinnings of TTS are largely unknown. Further studies dedicated to exploring the underlying molecular and cellular mechanisms may translate into effective therapies and approaches to halt and reverse the process and prevent tissue destruction and cosmetic disfigurement.
Entities:
Keywords:
Skin ulcer; street drugs; synthetic marijuana; trigeminal nerve diseases
Authors: Andrew A Monte; Alvin C Bronstein; Dazhe J Cao; Kennon J Heard; Jason A Hoppe; Christopher O Hoyte; Janetta L Iwanicki; Eric J Lavonas Journal: N Engl J Med Date: 2014-01-23 Impact factor: 91.245