Top

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Published in:

Open Access 01-12-2021 | Trigeminal Neuralgia | Case Report

Giant intracavernous aneurysm presenting with isolated trigeminal neuralgia: a case report

Authors: Fadhilah Hani Ishak, Abdul Hanif Khan Yusof Khan, Mohd Naim Mohd Yaakob, Mohd Fandi Al Khafiz Kamis, Anna Misyail Abdul Rashid, Wei Chao Loh, Janudin Baharin, Azliza Ibrahim, Liyana Najwa Inche Mat, Wan Aliaa Wan Sulaiman, Fan Kee Hoo, Hamidon Basri

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Abstract

Background

Trigeminal neuralgia (TN) commonly affects individuals aged more than 50 years and is mostly primary owing to trigeminal nerve neurovascular compression. We report a case of secondary TN attributed to a giant intracavernous aneurysm compressing the trigeminal nerve.

Case presentation

A 74-year-old female presented with classic TN symptoms, which were initially refractory to medical treatment. Imaging including MRI brain, MR angiography, and cerebral angiogram revealed a giant intracavernous aneurysm measuring 1.7 cm × 2.8 cm, inducing mass effect on the left Meckel's cave. Aneurysm embolization was challenging due to the difficult cannulation of the distal portion of the aneurysm. The patient opted for conservative management with mild improvement of symptoms.

Conclusions

Intracavernous aneurysm rarely present with isolated trigeminal neuralgia. This case report emphasizes that the assessment of the intracranial vasculature should be considered as part of the diagnostic imaging work-up for patients presenting with TN

Shankar Kikkeri N, Nagalli S. Trigeminal neuralgia. Treasure Island: StatPearls Publishing; 2020.

Trigeminal Neuralgia—Causes, Symptoms and Treatments. 2020. https://www.aans.org/Patients/Neurosurgical-Conditionsand-Treatments/Trigeminal-Neuralgia. Accessed 27 Aug 2020.

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87:117–32. https://doi.org/10.1093/bja/87.1.117.CrossRefPubMed

Trotter MI, Choksey MS. Facial pain with intracranial aneurysm. J R Soc Med. 2000;93:479–80. https://doi.org/10.1177/014107680009300908.CrossRefPubMedPubMedCentral

Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery. 2005;57:850–7. https://doi.org/10.1227/01.neu.0000179922.48165.42.CrossRefPubMed

Chakravarthi PS, Ghanta R, Kattimani V. Microvascular decompression treatment for trigeminal neuralgia. J Craniofac Surg. 2011;22:894–8. https://doi.org/10.1097/SCS.0b013e31821a07b7.CrossRefPubMed

Dzierzanowski J, Słoniewski P. Trigeminal neuralgia caused by aneurysm of the posterior cerebral artery: a case description and the analysis of anatomical variety of vascular complex in the root entry zone of Trigeminal nerve. Folia Morphol. 2014;73:224–8. https://doi.org/10.5603/FM.2014.0033.CrossRef

Sughrue ME, Saloner D, Rayz VL, Lawton MT. Giant intracranial aneurysms: evolution of management in a contemporary surgical series. Neurosurgery. 2011;69:1261–70. https://doi.org/10.1227/NEU.0b013e31822bb8a6.CrossRefPubMed

Brown A, Jolliff H, Poe D, Weinstock M. Intracavernous internal carotid artery aneurysm presenting as acute diplopia: a case report. Clin Pract Cases Emerg Med. 2020;4:362. https://doi.org/10.5811/cpcem.2020.3.45266.CrossRefPubMedPubMedCentral

10.

Goldenberg-Cohen N, Curry C, Miller NR, Tamargo RJ, Murphy KP. Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms. J Neurol Neurosurg Psychiatry. 2004;75:863–7. https://doi.org/10.1136/jnnp.2003.020917.CrossRefPubMedPubMedCentral

11.

Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010;3:107–15. https://doi.org/10.1177/1756285609359317.CrossRefPubMedPubMedCentral

12.

Sattur M, Saway BF, Lena J, Spiotta A. Endovascular management of a giant skull base cavernous aneurysm: parent artery occlusion is still a relevant strategy. Cureus. 2021. https://doi.org/10.7759/cureus.13643.CrossRefPubMedPubMedCentral

Title: Giant intracavernous aneurysm presenting with isolated trigeminal neuralgia: a case report
Authors: Fadhilah Hani Ishak
Abdul Hanif Khan Yusof Khan
Mohd Naim Mohd Yaakob
Mohd Fandi Al Khafiz Kamis
Anna Misyail Abdul Rashid
Wei Chao Loh
Janudin Baharin
Azliza Ibrahim
Liyana Najwa Inche Mat
Wan Aliaa Wan Sulaiman
Fan Kee Hoo
Hamidon Basri
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Trigeminal Neuralgia
Aneurysm
Aneurysm
Pregabalin
Intracranial Aneurysm
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2021
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-021-00365-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Giant intracavernous aneurysm presenting with isolated trigeminal neuralgia: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Quantitative motor unit potential analysis and nerve conduction studies for detection of subclinical peripheral nerve dysfunction in patients with compensated liver cirrhosis

Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers

A case series of post COVID-19 mucormycosis—a neurological prospective

Outcomes and issues of 12 chordomas treated in a single center

The impact of clinical scales in Parkinson’s disease: a systematic review

Predictive factors of epilepsy outcome in a sample of Egyptian pre-elderly and elderly population