Trigeminal neuralgia

Case contributed by Subash Thapa
Diagnosis almost certain

Presentation

Paroxysmal stabbing facial pain lasting for several minutes.

Patient Data

Age: 30 years
Gender: Female

MRI Brain

mri
This study is a stack
Sagittal
T1
This study is a stack
Sagittal
T2
This study is a stack
Axial 3d CISS
sequence
This study is a stack
Axial 3D VIBE
sequence
This study is a stack
Axial
T2
This study is a stack
Axial
T1
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
T2
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Info

T1, T2, and 3D CISS images show foci of signal void touching the cisternal segment of the right fifth cranial nerve.

3D VIBE image shows tortuous superior cerebellar artery touching the right trigeminal nerve.

Annotated image
This study is a stack
T1
Sagittal
This study is a stack
3D CISS
Axial
This study is a stack
T2
Sagittal
This study is a stack
3D VIBE
axial
Download
Info

Annotated images T1 sagittal, 3D CISS axial, T2 sagittal, 3D VIBE axial.

yellow - trigeminal nerve.

red - superior cerebellar artery.

Case Discussion

The trigeminal nerve is divided into four segments: brainstem, cistern, Meckel cave/ cavernous sinus and extracranial segments.

The common causes of trigeminal neuralgia (Tic douloureux) are 1:

  • brain stem segment: multiple sclerosis, infarct and glioma
  • cisternal segment: neurovascular compression, acoustic and trigeminal schwannomas, meningiomas, epidermoid cysts, lipomas and metastases
  • Meckel cave and cavernous sinus: meningiomas, trigeminal schwannomas, epidermoid cysts, metastases, pituitary adenoma and aneurysm.
  • extracranial: perineural tumor spread

Tortuous, elongated superior cerebellar artery (common), elongated anterior inferior cerebellar artery, vertebrobasilar dolichoectasia or venous compression are the causes of neurovascular compression in the cisternal segment of trigeminal nerve 1.

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