Trigeminal neuralgia secondary to cerebellopontine angle meningioma
50 years old male presented with right sided intensive episodic facial pain irradiating to periauricular region for 2 years. The patient was clinically diagnosed as a case of trigeminal neuralgia and treated with tablets carbamazepine. But pain did not respond to the treatment.
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Well defined homogeneously enhancing mass with dural tail in the right cerebellopontine angle, that is T1 hypointense and T2 mildly hyperintense. The lesion measures 17 x 14 x 12 mm. Coronal 3D T2 DRIVE images at the level of posterior fossa show that the lesion compresses the adjacent pons and cisternal segment of the trigeminal nerve.
Findings consistent with right cerebellopontine angle meningioma with trigeminal nerve compression.
Cerebellopontine angle tumours are not a frequent cause of trigeminal neuralgia.
The present case shows that a cerebellopontine angle meningioma can cause trigeminal nerve compression with resultant trigeminal neuralgia symptoms. We want to emphasize the importance of investigating each case of trigeminal neuralgia until reaching the correct diagnosis. If the patient has symptoms of trigeminal neuralgia, whether typical or atypical, brain MRI should be considered as the modality of choice.