Classical Trigeminal Neuralgia, Purely Paroxysmal With Vascular Compression - A Case Report

According to the 3rd edition of the international classification of headache disorders (ICHD3 2013), Trigeminal Neuralgia (TN) is classified into two types: 1. Classical TN, purely paroxysmal 2. Classical TN with concomitant persistent facial pain. In this article, the authors describe a 47 year-old, male with unilateral, severe, recurring, electric shock-like pain involving left lower jaw, teeth and gingiva. Diagnosis of classical TN of the left 3rd division of the trigeminal nerve was made. The patient was treated with pharmacotherapeutic agents but without relief. Magnetic resonance imaging (MRI) of the brain showed medial vascular compression of left trigeminal pontine root entry zone caused by superior cerebellar artery. A microvascular decompression (MVD) surgery was done at the left trigeminal pontine root entry zone resulting in good relief of pain. This article highlights the differential diagnoses to be considered with TN and also emphasize the difference between the two types of the TN according to ICDH3 (2013). It also highlights the difference between classical TN purely paroxysmal with and without vascular compression by imaging techniques and their differing treatment modalities, which therefore should be reflected in future ICDH classification.