Trigeminal neuralgia due to vertebrobasilar dolichoectasia

Case contributed by Mohamed Saber


Paroxysmal left facial pain, tics like pain that is increasing with chewing, smiling, and cold fluids

Patient Data

Age: 70 years
Gender: Male

MRI study shows the following:

  • dilated tortuous vertebrobasilar arteries (vertebrobasilar dolichoectasia), seen related to the course of left trigeminal nerve likely compressing it
  • ectasia of the other intracranial arteries
  • bilateral cerebral hemispheric chronic microangiopathy (Fazekas grade III)
  • bilateral basal ganglia multiple ischemic foci together with minute dilated Virchow Robin spaces
  • bilateral thalamic foci of blooming artifact in GRE (larger at the left side) likely related to hypertensive microangiopathy
  • age-related cerebral involutional changes
  • right frontal, bilateral ethmoid, and bilateral maxillary sinusitis


Case Discussion

Vertebrobasilar dolichoectasia is one of the causes of neurovascular compression syndrome (NVCS) as presented in this case where it is seen compressing the trigeminal nerve and presumably causing trigeminal neuralgia

It is important to note, however, that vascular ectasia and even distortion of the trigeminal nerve by an elongated vertebral artery is not an uncommon finding in asymptomatic individuals and as such the causal link in this instance is presumptive. 

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