Facial pain as a presenting feature of intracerebral haemorrhage

A literature review from 1966 using Medline with keywords 'cerebral haemorr hage' and 'facial pain' failed to reveal any cases in which facial pain was the initial feature of intracranial haemorrhage. The following case descri bes ipsilateral facial pain which is previously undescribed as a presentati on of intracranial bleeding. A 53 year old female who was previously well, with no significant history o f headache, developed right facial pain from the orbit to the maxilla. Ten to 15 min later she developed nausea and vomiting with unsteadiness and con fusion. She had difficulty with left-hand fine finger movements, with norma l sensation and reflexes but an extensor plantar response on the left. Faci al pain persisted for 3 days. Initial imaging revealed a 4 x 3 cm right tem poral lobe haemorrhage with mass effect and oedema extending into the subar achnoid space, Angiogram revealed a right temporal lobe arteriovenous malfo rmation, The basis of the pain remains speculative but includes sensation from the t orn vessel wall being referred to the face and subarachnoid blood irritatio n of the meninges in the middle cranial fossa, Another possibility is irrit ation of somatosensory cortex II, but why this should result in only ipsila teral pain is unclear. Facial pain should be an alerting symptom to the neu rologist when it appears with no apparent cause. (C) 2000 Harcourt Publishe rs Ltd.