Korean J Pain.  2005 Dec;18(2):218-221. 10.3344/kjp.2005.18.2.218.

The Dizziness Caused by a Vestibular Schwannoma was Misinterpreted as a Side Effect of an Anticonvulsants Drug: A case report

• Kim DH
• Hwang DS
• Park SW

• KMID: 2277993
• DOI: http://doi.org/10.3344/kjp.2005.18.2.218

Abstract

This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.

Keyword

anticonvulsant; dizziness; trigeminal neuralgia; vestibular schwannoma

MeSH Terms

Anticonvulsants*
Ataxia
Brain
Brain Neoplasms
Cheek
Chin
Diagnosis
Dizziness*
Humans
Hydrocephalus
Hyperalgesia
Hypesthesia
Magnetic Resonance Imaging
Mandibular Nerve
Mepivacaine
Middle Aged
Molar
Nerve Block
Neuroma, Acoustic*
Pain Clinics
Phenytoin
Stellate Ganglion
Tongue
Trigeminal Nerve
Trigeminal Neuralgia
Anticonvulsants
Mepivacaine
Phenytoin