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Table of Contents    
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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.128364

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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 2022 Aug 7];62:112. Available from: https://www.neurologyindia.com/text.asp?2014/62/1/112/128364


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)

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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


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