Trigeminal neuralgia

Case contributed by Dr Subash Thapa


Paroxysmal stabbing facial pain lasting for few minutes.

Patient Data

Age: 30 years
Gender: Female

MRI Brain

T1, T2, 3D CISS images show foci of signal void touching the cisternal segment of the right fifth cranial nerve.

3D VIBE image shows tortuous superior cerebral artery touching the right trigeminal nerve.

Annotated image

Annotated images T1 sagittal, 3D CISS axial, T2 sagittal, 3D VIBE axial.

yellow - trigeminal nerve

red - superior cerebellar artery

Case Discussion

The trigeminal nerve is divided into four segments: brainstem, cistern, Meckel cave/ cavernous sinus and extracranial segments.

The common causes of trigeminal neuralgia (Tic douloureux) are 1:

  • brain stem segment: multiple sclerosis, infarct and glioma
  • cisternal segment: neurovascular compression, acoustic and trigeminal schwannomas, meningiomas, epidermoid cysts, lipomas and metastases
  • Meckel cave and cavernous sinus: meningiomas, trigeminal schwannomas, epidermoid cysts, metastases, pituitary adenoma and aneurysm.
  • extracranial: perineural tumor spread

Tortuous, elongated superior cerebellar artery (common), elongated anterior inferior cerebellar artery, vertebrobasilar dolichoectasia or venous compression are the causes of neurovascular compression in the cisternal segment of trigeminal nerve 1.

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Case information

rID: 40308
Published: 18th Oct 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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