Neurovascular compression of trigeminal nerve

Case contributed by Dr Pavan Borra

Presentation

Right cheek pain and numbness for 6 months

Patient Data

Age: 65 years
Gender: Male

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.

Annotated image

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.

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Case information

rID: 67922
Published: 6th May 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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