Association between trigeminal neuralgia and multiple sclerosis: role of magnetic resonance imaging.

Abstract

Seven consecutive patients with multiple sclerosis and trigeminal neuralgia were investigated with MRI to determine the occurrence of a lesion which would account for the patients' pain. Two patients had bilateral symptoms. In the patients with unilateral trigeminal neuralgia vascular compression of the nerve by an artery at the root entry zone on the symptomatic side was confirmed in three patients and an epidermoid tumour distorting the nerve on the symptomatic side was identified in one patient. A demyelinating plaque was identified in only one patient, affecting the trigeminal nerve at the root entry zone at the pons. In those with bilateral symptoms neurovascular compression was identified on both sides in one patient and on one side only in the remanng patient. Microvascular decompression cured the pain in two patients with neurovascular compression. The variable aetiology of trigeminal neuralgia is stressed even in patients with coexistent neurological conditions such as multiple sclerosis, which can cause trigeminal neuralgia independent of other causes. (7 Neurol Neurosurg Psychiatry 1995;59:253-259)

Multipl sklerozda ağrı ve klinik özelliklerle ilişkisi

“…Its mechanisms are still debated and some neuroimaging studies mention demyelinating plaques in the pons of the patients with neuralgia (20). Meaney et al argued that this could be coincidental (21). Pichiecchio et al, on the other hand, put it down to peripheral involvement (22).…”

Accommodation to Diagnosis of Trigeminal Neuralgia

“…It is also possible that there is a role of the central pain mechanisms. Demyelination of one or more of the trigeminal nerve nuclei may also be caused by multiple sclerosis or other structural lesions of the brainstem, although vascular compression has also been noted in these patients 17 . Th e International Classifi cation of Headache Disorders, 3 rd edition (ICHD-3) classifi es TN into two categories: classic TN that encompasses idiopathic TN and TN caused by neurovascular compression, and painful trigeminal neuropathy caused by many other conditions mentioned before 4 .…”

Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up

“…In the case of MS, a plaque of demyelination encompasses the root entry zone of the trigeminal nerve in the pons [21]. Additionally, several studies have also described the association of a neurovascular conflict in a minority of patients [4,22,23,24]. Love and Coakham [20] demonstrated that demyelination is found to extend along the proximal part of the trigeminal nerve root and, in some cases, right up to its junction with the peripheral nervous system.…”