TMSS Medical College Journal

Abstract Introduction: Trigeminal neuralgia is a worry some clinical condition causing pain along distribution trigrminal nerve. Cause identification is necessary to provide exact management of this painful condition. MRI is one of the best imaging modalities to find out aetiology of this disease. Materials and Methods: This descriptive cross sectional study was carried out in enrolling suspected subjects from Multicenter Trigeminal neuralgia for a period of eight months. MRI was carried out in all the cases with conventional sequences with MRA and 3D FIESTA protocol for Trigeminal nerve. Results: The aetiology of neuralgia were vascular compression (75.71%), CP angle mass (15.38%) and Mass in Meckel’s cave (11.53%). Cause was not identified at 15.38% cases. Left trigeminal nerve was affected in most of the cases (61.54%). Aberrant direction of Vertebral artery was most common (33.34%) cause of vascular compression. Most of the patients presented with pain, which was intense (about 46.15%) sudden (38.46%) in nature. Pain was was triggered by precipitating factors in 30.76% cases. Conclusion: MRI was able to find out cause of Trigeminal neuralgia in most of the cases. So, MRI with 3D FIESTA protocol for Trigeminal nerve with MRA is advised for suspected cases of Trigeminal neuralgia referred by physicians.

Trigeminal neuralgia (TN), also known as tic douloureux is a clinical manifestation of sudden paroxysmal pain in face along distribution of Trigeminal nerve. Diagnostic criteria are there would at least three attacks of unilateral facial pain occurring in one or more division of trigeminal nerve and no radiation beyond its distribution. Sometimes, the pain often leaves patients with uncontrollable facial twitching." Exact prevalence of trigeminal neuralgia is exactly unknown in Bangladesh. However, trigeminal neuralgia affects subjects between 21 and 87 years with a mean age of 50.62 years in India. Mandibular nerve is involved in most of the cases (56.9%), right side of the face (57.1%) is more involved than the left side. Other study showed prevalence was 4 to 13 per 100,000 people per year." The most common cause of trigeminal neuralgia is compression of cisternal portion of the trigeminal nerve by loop of an artery or vein compressing the. Vascular contact deforming the trigeminal nerve is seen in about 15% of cases. Nerve root entry zone is the site where the nerve exits the brainstem. There is transition zone of approximately 2 mm in length and this area is vulnerable than any other part of the nerve to be involved. Other rare cause of Trigeminal neuralgia are posterior fossa tumors, most commonly vestibular schwannomas, meningiomas, arachnoid cysts, or epidermoid cysts.>*” Multiple sclerosis may be responsible for trigeminal neuralgia and, indeed, its incidence is much higher in multiple sclerosis patients than in the general population.*®* From this knowledge dedicated protocol including T2 or T1 volumetric acquisition techniques with thin slices in all three planes should be helpful.” Authors suggested Diffusion weighted imaging can be used to assess the cisternal and brainstem components of the nerve and assess ADC values, fractional anisotropy and mean diffusivity." The most challenging aspect of trigeminal neuralgia treatment is maintaining pain control to improve patients’ quality of life. Patients with intractable pain may require surgical referral. Clinicians should screen and treat patients for comorbid depression and anxiety, which may negatively affect treatment efficacy and outcomes in trigeminal neuralgia.*!*!" The initial treatment of trigeminal neuralgia is medical, with carbamazepine and/or gabapentin, However, large surgical series have confirmed that microvascular decompression of the trigeminal nerve root is an efficient and durable treatment for trigeminal neuralgia. Other advanced procedures include, Gamma Knife radiosurgery, thermal, chemical, or mechanical controlled rhizotomies of the trigeminal ganglion or root and trigeminal nerve stimulation which is considered "off-label" use (2019) in the USA.**!" This present descriptive cross sectional study was carried out to find out possible cause of Trigeminal neuralgia in Bogura District, Bangladesh. MRI is becoming one of popular, available modality in peripheral part of Bangladesh, outside Capital Dhaka. The finding of the study will help the Clinician as well as Radiologist to find out aetiology of Trigeminal neuralgia.