FIG 6. Patient 13: 25-year-old woman with pain in the first trigeminal division. Sensory loss was found in all three trigeminal divisions, and oculomotor, abducens, and facial nerve palsies were present. Blink reflex recorded to left supraorbital nerve stimulation showed a delayed R1 and normal R2 components. The left jaw-jerk reflex response was absent. The left masseter inhibitory reflex showed an afferent delay (ie, a bilateral delay of the first and second silent periods). All reflex responses were normal after stimulation of the right side. The abnormal reflex findings corresponded to a proximal trigeminal nerve lesion, probably at the root level.

A and B, Axial (A) and coronal (B) contrast-enhanced T1-weighted MR images show enhancement and thickening of the trigeminal ganglion and proximal third division of the trigeminal nerve in the foramen ovale (arrows). Follow-up MR imaging studies (not shown) and clinical findings showed resolution of the abnormalities, indicating an inflammatory lesion.