An unusual case of vascular loop syndrome

Abstract

Coexistence of hemifacial spasm (HFS) and trigeminal neuralgia (TN) is a rare entity known as painful tic convulsif (PTC). Here, we present a case of right-sided HFS after which left TN developed, which is an unusual form of PTC. Both disorders were caused by bilateral vascular compression of the cranial nerves and successfully treated with botulinum toxin and carbamazepine. As PTC is benign in nature and can be treated with botulinum toxin, neuroradiological investigations should be performed for an accurate aetiological diagnosis, particularly in young patients with atypical disease manifestations.

Trigeminal Neuralgia in a Patient with Vascular Loop Triggered by Hypertension

“…From this perspective hypertension may exacerbate the arterial tortuosity at the brainstem and increase the chance of developing neurovascular compression, which in turn, contributing to a higher risk for TN [2]. Hypertension also accelerates atherosclerotic changes, causing the formation of ectatic vessels and resulting in the development of vascular compression [7]. In the present case the trigeminal nerve was compressed by a vascular loop and this finding was confirmed by MRI.…”

“…The exact patophysiology of TN is still unknown. Although several theories have been proposed to determine the aethiology, most reports concentrate on the anatomic relation between the nerves and the juxtaposed vascular loops [7]. In majority of TN cases the trigeminal nerve root entry zone has been found to be compressed by an aberrant loop of artery or vein, which ultimately leads to demyelination of the trigeminal nerve [6].…”

Intraoral administration of botulinum toxin for trigeminal neuropathic pain

“…Several case reports have suggested that botulinum toxin injected into the hyperalgesic tissue may be helpful at reducing spontaneous and provoked pain of neuropathic origin (13)(14)(15)(16)(17)(18)(19). A few small randomized clinical trials have been conducted and also suggested that botulinum toxin may be helpful in the treatment of neuropathic pain, namely painful peripheral diabetic neuropathy (20), CRPS (21), and trigeminal neuralgia (22).…”

OnabotulinumtoxinA for trigeminal neuralgia: a review of the available data

“…Reporting a case similar to the one that motivated a previous study by our group 4 , Jankovic described a patient who presented with hemifacial spasm and TN whose TN improved after treatment of the hemifacial spasm with BoNT/A. Since then, case reports and case series have been published in neurology, headache, pharmacology and pain medicine journals 6,7,8,9,10,11,12,13,14 . This literature, although suggesting the therapeutic effects of BoNT/A in TN, has been challenged 15 or even ignored by panels of experts 16,17 .…”