Trigeminal Neuralgia in a Patient with Vascular Loop Triggered by Hypertension

Abstract

Trigeminal neuralgia (TN) is characterized by paroxysms of severe, lancinating, electric shock-like bouts of pain restricted to the distribution of the trigeminal nerve. The pain predominantly occurs unilaterally and involves the mandibular and /or maxillary branch or, rarely, the ophtalmic branch [1]. Most cases are classic or primary TN, which lacks objective evidence of motor or sensory deficit and is not attributed to another disorder, while a minority of cases are symptomatic or secondary TN, which is related to underlying causes such as multiple sclerosis, vascular compression and tumors [2,3]. However most cases are not associated with abnormalities on conventional MRI taken with inappropriate techniques. It has been mentioned in the literature that TN is usually caused by vascular compression of the trigeminal nerve root at the brainstem by a tortuous vessel. This compression results in demyelination of the nerve root entry zone, leading to ectopic impulse generation, ephaptic transmission of impulses, and the symptoms of TN [2].