Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 752  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (316 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1745    
    Printed41    
    Emailed0    
    PDF Downloaded69    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGE
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 112

Missing trigeminal nerve found in trigeminal neuralgia


Department of CT/MRI, ESIC Hospital, Mumbai, Maharashtra, India

Date of Web Publication7-Mar-2014

Correspondence Address:
Prashant S Naphade
Department of CT/MRI, ESIC Hospital, Central Road, Andheri East, Mumbai - 400 093, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128364

Rights and Permissions



How to cite this article:
Naphade PS, Keraliya AR. Missing trigeminal nerve found in trigeminal neuralgia. Neurol India 2014;62:112

How to cite this URL:
Naphade PS, Keraliya AR. Missing trigeminal nerve found in trigeminal neuralgia. Neurol India [serial online] 2014 [cited 2019 Sep 18];62:112. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/112/128364


Sir,

A 45-year-old woman presented with intermittent episodes of severe pain on the left half of the face and neck consistent with trigeminal neuralgia. Clinical examination was unremarkable. Magnetic resonance imaging brain revealed tortuosity of vertebrobasilar arteries. Right trigeminal nerve appeared normal [[Figure 1]a and c, thin arrow]. Left vertebral artery is in the expected location of left trigeminal nerve with non-visualization of left trigeminal nerve on 3D T2 DRIVE (Driven equilibrium radiofrequency reset pulse) and 3D T1 sequences [[Figure 1]b and d, long thick arrow]. However, further evaluation with 3D fluid attenuated inversion recovery (FLAIR) image clearly demonstrated tortuous left vertebral artery causing severe indentation on left trigeminal nerve throughout its cisternal component [[Figure 1]e, short thick arrows]. Severe thinning of left trigeminal nerve was seen suggestive of atrophy. Trigeminal nerve atrophy probably occurred secondary to demyelination and axonal loss. Non-visualization of atrophic trigeminal nerve on 3D T1 and DRIVE sequences was secondary to the absence of CSF around the nerve which lied between the left vertebral artery and adjacent brain parenchyma. This case illustrates severe trigeminal atrophy in trigeminal neuralgia and the use of 3D FLAIR sequence in demonstrating atrophic nerve.
Figure 1: DRIVE (3D-T2W-driven equilibrium radiofrequency reset pulse) and 3D T1 reformatted right (a and c) and left (b and d) sagittal oblique images reveals normal right trigeminal nerve (thin arrow) with nonvisualization of left trigeminal nerve (long thick arrow). Tortuous left vertebral artery is displacing the severely atrophic left trigeminal nerve (short thick arrows) on 3D fl uid attenuated inversion recovery image (e)

Click here to view


Trigeminal neuralgia usually occurs in middle age females with predominant affection of mandibular and maxillary divisions of the trigeminal nerve. [1] Approximately 90% of cases are secondary to compression of root entry zone by overlying superior or anterior cerebellar arteries. Less common causes including multiple sclerosis and neoplasm should be considered in younger patients with motor and/or sensory deficits. Abutment of the trigeminal nerve by adjacent artery can also be seen in normal asymptomatic individuals and therefore not specific for the diagnosis of trigeminal neuralgia. [2] Radiological findings increasing the specificity of diagnosis include displacement/distortion of the trigeminal nerve and atrophy of the trigeminal nerve on symptomatic side when compared with normal reference contralateral trigeminal nerve.

 
  References Top

1.Sanders RD. The trigeminal (V) and facial (VII) cranial nerves: Head and face sensation and movement. Psychiatry (Edgmont) 2010;7:13-6.  Back to cited text no. 1
    
2.Majoie CB, Verbeeten B Jr, Dol JA, Peeters FL. Trigeminal neuropathy: Evaluation with MR imaging. Radiographics 1995;15:795-811.  Back to cited text no. 2
    


    Figures

  [Figure 1]

This article has been cited by
1 Application of Antidromic Conduction Monitoring in Ganglion Radiofrequency Thermocoagulation for Locating Trigeminal Branches in Trigeminal Neuralgia
Xiuhua Li,Jianning Yue,Liqiang Yang,Huijie Yang,Shuyue Zheng,Liangliang He,Jiaxiang Ni
Pain Practice. 2015; : n/a
[Pubmed] | [DOI]
2 Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction
M. Pihut,M. Szuta,E. Ferendiuk,D. Zenczak-Wieckiewicz
BioMed Research International. 2014; 2014: 1
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow