A Case of Trigeminal Neuralgia and Neurogenic Hypertension Due to Megadolichobasilar Artery Anomaly.

Abstract

We report neuroradiological findings in a unique case with mega-dolichobasilar artery and trigeminal neuralgia and neurogenic hypertension. A 39-year-old man with hypertension and trigeminal neuralgia received the first physical check-up in PL Tokyo Health Care Center.Physical check-up suggested moderate degree of obesity, severe degree of hypertension, hyperlipidemia and hyperuricemia. Neurological examination showed paresthesia in the right lower face, auditory disturbance in the right side and horizontal nystagmus to the right direction. Magnetic resonance imaging showed the dilated and tortuous basilar artery compressing the pons and the left ventrolateral medulla oblongata. Magnetic resonance angiography (MRA) demonstrated megadolichobasilar artery anomaly. The resource images of MRA revealed compression to the root entry zone of the right trigeminal nerve by the ectatic basilar artery and the neurovascular contact of the right vestibulocochlear nerve.Megadolichobasilar artery anomaly causes dysfunction of the cranial nerves, cerebral ischemia and hemorrhage. Our neuroimages indicate that the megadolichobasilar artery compresses the root entry zone of the ipsilateral trigeminal nerve, the vestibulocochlear nerve and the left ventrolateral medulla, leading to trigeminal neuralgia, vestibulocochlear deficits and marked hypertension in our patient. Thus, the resource images of MRA have benefits for pathognomonic evaluation of the neurovascular structure.