Clinical presentations of trigeminal neuralgia in patients with dolichoectasia of the basilar artery

Abstract

Described are clinical presentations of trigeminal neuralgia (TN) in 3 cases verified as pathogenetically related to neurovascular conflict of the two arteries, basilar and anterior inferior cerebellar. Neurological symptoms in these patients included a number of symptoms characteristic of classical neuralgia: transient paroxysmal pain in the trigeminal nerve innervation zones, predominantly corresponded to branches 2 and 3 and lasting for seconds to minutes; algetic attacks provoked by non-pain stimulation of the trigger zone or by oral toileting, speech, shaving, making up, etc; long duration of the disease with periods of remission; efficacy of carbamazepine at early stages of the disease. These features combined with symptoms of the trigeminal root involvement, but without any signs of spread of the process to nearby brain anatomic structures, the latter being characteristic of symptomatic (secondary) TN. Unlike classical TN, pain paroxysms occurred also at night. In the interictal period dull pain remained, in contrast to a pain-free refractory period characteristic of classical TN. The above clinical symptoms allowed us to suspect, already at the clinical stage of examination, a neurovascular conflict with the dolichoectatic basilar artery, with the corresponding recommendation to undergo multispiral CT angiography that confirmed our diagnosis.