BACKGROUND: The anterior surgical approach to the cervical spine is known to be safe, and damage to the hypoglossal nerve and trigeminal pathway after the surgery is uncommon. However, once damage to those nerves occurs, the patient\'s quality of life can be severely impaired by discomfort and disability.
METHODS: We report the case of a 59-year-old male with concomitant and irreversible hypoglossal nerve and trigeminal system dysfunction after cervical spine surgery by the anterior approach confirmed by an electrodiagnostic study. He had undergone anterior cervical disc fusion through right-sided approach for a herniated intervertebral disc on the C3-4 level and direct cord compression. He had difficulty with tongue movement, dysarthria, and hypesthesia along the lower margin of the right mandible immediately after the surgery. An electrodiagnostic study revealed hypoglossal neuropathy and trigeminal somatosensory pathway dysfunction. Even though the patient received rehabilitation therapy for impaired tongue movement for more than 2 years, this function did not recover.
CONCLUSIONS: It is important to be aware of the complexity of the anatomy of vulnerable structures, including hypoglossal nerves and the trigeminal nerve system at the cervical spine level, to prevent damage to important neural structures during surgical procedures.

BACKGROUND: Herpes zoster ophthalmicus (HZO) is an inflammation related to reactivation of the latent varicella zoster virus (VZV), involving the ophthalmic branch of the trigeminal nerve. Optic neuritis (ON), a rare ocular complication following HZO, has been reported in 1.9% of HZO-affected eyes. Most previous cases occurred simultaneously with other ocular complications, especially orbital apex syndrome. Moreover, detailed magnetic resonance imaging (MRI) with diffusion weighted imaging of the optic nerve and trigeminal nucleus in HZO-related ON has been rarely reported. We report a case of postherpetic isolated ON with a concurrent abnormal trigeminal nucleus on imaging.
METHODS: A healthy 58-year-old female presented with sudden painful visual loss in her right eye for 2 days. Four weeks before the presentation, her right eye was diagnosed with HZO, and she received intravenous acyclovir for 10 days. Ophthalmic examination revealed a visual acuity of light perception and 20/20 in the right and left eyes, respectively. A relative afferent pupillary defect was present in the right eye. Neurological examination was significant for hypoesthesia in the area of the HZO. A clinical diagnosis of HZO-related right retrobulbar ON was made, and other causes of atypical ON were excluded. MRI showed enhancement and restricted diffusion of the right-sided optic nerve with linear hyperintense T2 of the right-sided spinal trigeminal nucleus and tract (STNT) along the brainstem. She received 14 days of intravenous acyclovir and 5 days of methylprednisolone. Both were switched to an oral route for 2 months. After the completion of treatment, the visual acuity was counting fingers and 20/20 in the right eye and left eye, respectively. Stable brainstem STNT abnormalities and resolution of ON were found radiologically.
CONCLUSIONS: Isolated ON is a rare ocular complication following HZO. An abnormal high signal of STNT on a T2 weighted image may be present, which may be a clue for VZV-associated complications, such as HZO-related ON, especially in cases lacking an obvious history of HZO or other concomitant ocular complications. Prompt treatment with both acyclovir and corticosteroids should be started. Restricted diffusion of the optic nerve may be a predictor for poor visual recovery.

Tinnitus is one of the 20 most common reasons why patients aged 45-64 years consult a general practitioner in Germany. In the literature a correlation is claimed between disease patterns of the cervical spinal column and nuclei of cerebral nerves. In the case report presented here, a 30-year-old female patient with acute tinnitus after acute hearing loss was cured from her tinnitus after a single manual medical treatment at C0/C1, which supports the correlation claimed. If cervical spine diseases should therefore regularly be included in the differential diagnoses of acute tinnitus is a matter of further research.

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Persistent idiopathic facial pain, once called atypical facial pain, rarely anticipates the detection of a lung carcinoma. Thirty-six cases of intractable facial pain secondary to lung neoplasm are described in the literature. The onset of facial pain usually precedes the onset of symptoms and signs due to lung cancer by several months and therefore it should be considered, when present, as a possible marker for an early diagnosis of tumour. We report a case of intractable facial pain associated with metastatic lung cancer in a non-smoker.

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An unusual case of cerebral actinomycosis of the Gasserian ganglion is reported. The location and the pathological diagnosis of granuloma are both extremely rare. The literature is briefly reviewed with special reference to similar reports. The manner of spread and the course of the disease are described. The present case tends to confirm the opinion that primary cerebral actinomycosis is extremely rare and probably does not exist. The case also definitely indicates that the organism reaches the central nervous system by way of nerve or perineural pathways.

A case of trigeminal root neurinoma presenting as atypical trigeminal neuralgia was reported. The orbicularis oculi reflex was absent on the affected side, but reappeared after operation. The demonstration of the tumor was much clearer on magnetic resonance imaging. The usefulness of these electrophysiological and radiological studies in differentiating varied entities of trigeminal neuralgia is stressed.

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