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Year : 2013  |  Volume : 61  |  Issue : 5  |  Page : 566--567

Hypertrophic trigeminal nerves: Moustache sign

Satish V Khadilkar, Devshi R Visana, Abhinay M Huchche, Neha Shah, Niharika Gupta, Nadir E Bharucha 
 Department of Neurology, Bombay Hospital Institute of Medical Science and Research, Mumbai, Maharashtra, India

Correspondence Address:
Satish V Khadilkar
110, New Wing, Bombay Hospital, 12, New Marine Lines, Mumbai - 400 020, Maharashtra

How to cite this article:
Khadilkar SV, Visana DR, Huchche AM, Shah N, Gupta N, Bharucha NE. Hypertrophic trigeminal nerves: Moustache sign.Neurol India 2013;61:566-567

How to cite this URL:
Khadilkar SV, Visana DR, Huchche AM, Shah N, Gupta N, Bharucha NE. Hypertrophic trigeminal nerves: Moustache sign. Neurol India [serial online] 2013 [cited 2022 Jun 29 ];61:566-567
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Full Text

We describe an interesting imaging finding in two patients, one with chronic inflammatory demyelinating polyneuropathy (CIDP) and the other having neurofibromatosis. The trigeminal nerves were hypertrophied, giving the appearance of a moustache-'the moustache sign'.

Case 1

A 17-year-old girl presented with subacute, fluctuating, distal and proximal limb weakness, distal hypoesthesia, and generalized areflexia. Electrophysiology confirmed demyelination with multifocal conduction blocks at nonentrapment sites in all four limbs. Cerebrospinal fluid examination showed albumin-cytological dissociation. Magnetic resonance imaging (MRI) revealed bilateral thickening and enhancement of cisternal segment and all three divisions (ophthalmic, maxillary, and mandibular) of the trigeminal nerve [Figure 1]. Spinal roots were hypertrophied as well. Cranial nerve hypertrophy is seen in 11-57% patients with CIDP. [1]{Figure 1}

Case 2

A 30-year-old male presented with sensory ataxia, areflexia, distal weakness, and wasting of all four limbs. MRI showed multiple intraspinal schwannomas, meningiomas, ependymomas, and bilateral vestibular schwannomas. The trigeminal nerves were thickened [Figure 2].{Figure 2}

Besides these two causes, trigeminal nerve may be enlarged in the following conditions: (1) Infections: Tuberculosis, syphilis, leprosy, mycoplasma, Lyme's disease; (2) immune mediated: Polyneuritis cranialis, chronic inflammatory demyelinating polyradiculoneuropathy, sarcoidosis, Wegener's granulomatosis, pachymeningitis, Tolosa Hunt syndrome; (3) neoplastic: Carcinoma, lymphoma/leukemia, myeloma, neurofibroma, schwannoma; (4) physical/toxins: Radiation, trauma, surgery, toxins; and (5) Hereditary: Hereditary neuropathies and leukodystrophies. [2]


Department of Radiology, Bombay Hospital, Mumbai.


1Shah S, Chandrashekar H, Manji H, Davagnanam I. Image of the moment: Cranial nerve, spinal root and plexus hypertrophy in chronic inflammatory demyelinating polyneuropathy. Pract Neurol 2012;12:68-9.
2Majoie CB, Verbeeten B Jr, Dol JA, Peeters FL. Trigeminal neuropathy: Evaluation with MR imaging. Radiographics 1995:4:795-811.