Presentation
Right cheek pain and numbness for 6 months
Patient Data
A vascular loop of the right superior cerebellar artery is in contact with the medial surface of the proximal cisternal segment of the right trigeminal nerve, and there is apparent thinning deformity of the nerve at this location. The left trigeminal nerve is normal.
Coronal image showing deformity of the right trigeminal nerve by a vascular loop (arrow).
Case Discussion
Based on the clinical findings and involvement of ipsilateral side with no other apparent cause, the diagnosis of trigeminal neuralgia due to vascular compression was suggested.
The patient was treated symptomatically without surgical intervention.
Neurovascular compression syndrome is caused by direct contact with mechanical irritation of cranial nerves by blood vessels.
Not all cases of neurovascular compression are symptomatic. The transitional zone between central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression. Proximal involvement of the proximal nerve is more likely to be symptomatic with trigeminal neuralgia.