Orofacial neuralgia associated with a middle cerebral artery aneurysm

Abstract

Chronic orofacial pain of neuropathic origin can present diagnostic and management dilemmas to dental practitioners and also affects the patient's quality of life. Intracranial aneurysms are a potential cause of stroke (e.g. sub‐arachnoid haemorrhage) that is usually associated with, high rates of mortality and morbidity. A patient who had been previously managed for symptoms of temporomandibular joint disorder (TMD) presented with sharp, shooting pain of moderate intensity. It was precipitated by swallowing, and radiated to the right throat, posterior border of the mandible, ear and temporomandibular joint. Clinical and radiological investigations ruled out odontogenic pain, TMD and other more common types of facial pain. Magnetic resonance imaging revealed a 7 × 6 mm aneurysm in the right middle cerebral artery (MCA) which was subsequently surgically clipped. Interestingly, the facial pain resolved after this procedure. Compression of the insular region of the brain innervated by the trigeminal, glossopharyngeal and vagus nerves provides a plausible explanation for the pain reported. To our knowledge, this is the first case of facial neuralgia associated with an aneurysm in the MCA which emphasizes the importance of a multidisciplinary approach in the diagnosis and management of unusual cases of chronic orofacial pain.

Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit

“…6 Approximately, 3% of the general population develop cerebral aneurysms and may not be diagnosed, until they enlarge sufficiently to cause symptoms or rupture. 16 However, more than 70% of aneurysms detected by Imaizumi and colleagues 6 using advanced imaging technique were ≤3 mm in diameter. 16 The current study, collected data from patients with complicated and ruptured aneurysmal cases, who were referred to the Neuro-interventional Centre in RAH for treatment.…”

“…16 However, more than 70% of aneurysms detected by Imaizumi and colleagues 6 using advanced imaging technique were ≤3 mm in diameter. 16 The current study, collected data from patients with complicated and ruptured aneurysmal cases, who were referred to the Neuro-interventional Centre in RAH for treatment. Imaizumi and colleagues 6 conducted the study on healthy and asymptomatic adults and detected the right ICA territory as the most common location (78%) for the development of intracranial aneurysms.…”