Late Onset Multiple Sclerosis: An Underlying Disease for Trigeminal Neuralgia

Introduction: Late onset Multiple Sclerosis (LOMS) is a rare condition characterized by the first outbreak of the disease at or above the age of 50 years old. On the other hand, Trigeminal Neuralgia (TN) is a shock-like hemi-facial headache. What both might have in common is the association with the demyelination process. While LOMS is strictly related to loss of myelin sheath, TN if often related to neurovascular compression, but when it doesn’t, demyelination stands for a probable implicated pathophysiology. At certain population, TN might be the first symptom of LOMS. Case Presentation: Our patient is a 65 year-old female who develops a severe hemi-facial shock-like headache. At first, examiners thought to be dealing with a primary form of TN due to absence of motor or other sensorial symptoms referred by the patient. Although, CNS images were not consistent with the initial hypothesis, revealing an impressive LOMS pattern. Conclusion: physicians should always consider LOMS as an underlying disease for patients, at or above 50 years old, manifesting TN as an isolated symptom. This may alert for earlier MS diagnosis and correct therapy strategies for these patients.