Lateral Medullary Infarction Secondary to Vertebral Artery Dissection Presenting as a Trigeminal Autonomic Cephalalgia

Abstract

A 51-year-old woman had an attack of severe hemifacial pain with autonomic features as the presenting symptom of a lateral medullary infarction. A bilateral vertebral artery dissection was demonstrated. The existence of secondary cases may lead to a better understanding of the pathophysiology of trigeminal autonomic cephalalgias.

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

“…Facial pain in IVAD is rare; only 9 cases have been reported [3–10]. In eight of them, symptoms and signs of medullary ischemia, such as dizziness/vertigo [4–9], ataxia [6–10], sensory disturbances [7–10], and more [6–10], either preceded [6, 7, 9, 10] or coincided [4, 5, 8] with facial pain; these clinical features helped diagnosis. Furthermore, MRI revealed medullary infarction in these cases, which further facilitated diagnosis.…”

Undifferentiated Trigeminal Autonomic Cephalalgia in Lateral Medullary Infarction

“…Undifferentiated trigeminal autonomic cephalalgias have been reported in various intracranial and extracranial neurovascular and CNS structural lesions, including pituitary tumours, cavernous sinus disease, spinal cord infarctions, [3][4][5] and vertebral dissection. 6,7 Although our patient did not have a cervico-cranial dissection on MR and CT angiography, these tests have been reported to show variable specificity and sensitivity in the diagnosis of arterial dissection when compared with digital subtraction four-vessel angiography. 8 The occurrence of TAC in lateral medullary infarction suggests trigeminal dysfunction, possibly due to involvement of the spinal trigeminal nucleus and central disinhibition of the trigeminal nociceptive pathways.…”

Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report

“…This supposition was confirmed when lighttouch sensation over the trigeminal nerve's distribution was unaffected. Vertebral artery dissection can occur in whiplash and has been reported to manifest as unilateral facial pain (Galende et al, 2004). However, no other subjective information suggested vertebrobasilar insufficiency, and the patient did not have any change in symptoms with sustained rotation.…”