Trigeminal neuralgia due to vertebrobasilar dolichoectasia

Case contributed by Mostafa Elfeky
Diagnosis almost certain


Left trigeminal neuralgia.

Patient Data

Age: 50 years
Gender: Male

The basilar and vertebral arteries are mildly dilated with markedly tortuous course to the left of the brainstem, in keeping with vertebrobasilar dolichoectasia. Basilar artery tip is higher in position in the right side of suprasellar cistern in relation to M1 segment of right middle cerebral artery and exceeding to a higher level. It is compressing the left side of the brainstem, mainly the pons, with no related encephalomalacia. It courses at left-sided CSF cisterns at the level of brainstem crossing the anatomical location of left trigeminal nerve root. 

Involutional brain changes seen as widening of brain sulci and diffuse high T2 and FLAIR white matter foci mainly involving subcortical white matter mostly representing cerebral small vessel disease.

Case Discussion

Vascular compression of the cisternal portion of the trigeminal nerve is the most common etiology for trigeminal neuralgia, most commonly the superior cerebellar artery. In this case, the compression is made by the basilar artery in the setting of vertebrobasilar dolichoectasia

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