Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain

Abstract

Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN.

Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-like Facial Pain

“…While one involved facial pain that mimicked cluster headaches, [9] the other involved facial pain presenting as trigeminal neuralgia, same as that observed in the present case [3]. In the latter case, despite the confirmation of vertebral artery dissection through MRA, only simple analgesics were prescribed and the facial pain gradually improved over the course of 4 weeks.…”

“…Only 2 cases of isolated facial pain without the symptoms or signs of medullary ischemia have been reported [3,9]. While one involved facial pain that mimicked cluster headaches, [9] the other involved facial pain presenting as trigeminal neuralgia, same as that observed in the present case [3].…”

“…According to Hosoya et al the initial symptoms of IVAD most frequently involve severe headache and dizziness (39%), followed by nausea and vomiting (32%), dysarthria, tinnitus, and diplopia (14% each) [1]. Cases of IVAD presenting with facial pain are rare, with only 10 cases reported so far [3][4][5][6][7][8][9][10][11]. Eight of these cases were accompanied by symptoms or signs of medullary ischemia (e.g., dizziness, [4-7,10,11] ataxia, [6-8,10,11] and sensory abnormalities [6,8,10,11]); medullary infarction was confirmed on MRA, which helped the diagnosis of vertebral artery dissection.…”

“…However, IVAD rarely presents with isolated facial pain; trigeminal neuralgia-like facial pain is even rarer, and only a single case has been reported in 2015 [3].…”

Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions

“…Comparing secondary SUNCT/SUNA to ICHD‐3 beta painful trigeminal neuropathy, in other words “secondary TN,” there is some overlap, eg, with respect to herpes zoster, MS and trauma . In addition, arteriovenous malformations, brainstem ischemia, and vertebral artery dissection, as well as Chiari I malformation have also been reported in TN . The most striking difference is found for pituitary adenomas which were associated with SUNCT but do not cause TN.…”