Tuesday 16 June 2015

Atypical Trigeminal Neuralgia MRI

Clinical details: right side trigeminal neuralgia.


Multi planner multi echo MRI study of brain has been performed. Sequences planned are FSE T1W, FSE T2W, FLAIR, T2w *GRE and DW images. FIESTA for cranial nerves.
Pc t1

This MRI Brain shows:
Abnormal T2 hyper intensity in right half of Pons at the entry point of right side trigemninal nerve, and adjacent right side trigeminal nerve_ significant for patients clinical complaints.
There is faint high signal on DW images in corresponding region.
No abnormal enhancement on post contrast T1.

Possibilities given were Demyelination, Ischemia.

He was prescribed
Amytryptiline 25 mg HS
Wyselon 20mg daily for 5 days, 10 mg for next 5 day and then stop
Gabapentine 300mg BD

During follow up after 2 weeks
He was clinically improved by 75 % which goes in favor of Demyelination.
During this follow up, MRI imaging shows lesion is same in size without any significant change on T2w images. The faint hyper intensity which was seen in previous MRI was reduced.
Advised further follow up imaging.

Current clinical status after 2 months, 100% improved.

There are persuasive evidences that trigeminal neuralgia is usually caused by demyelination of trigeminal sensory fibres within either the nerve root or, less commonly, the brainstem at the entry point of nerve. However in most cases, the trigeminal nerve root demyelination involves the proximal, CNS part of the root and results from compression by an overlying artery or vein.

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