Question

The most common cause of trigeminal neuralgia is?

• A. Infection
• B. Trauma
• C. Vascular compression
• D. Iatrogenic

Hint:

Think of a neurovascular conflict at the nerve root entry zone near the brainstem.

Answer 1

The Correct Option is C

Step 1: Trigeminal neuralgia (tic douloureux) is characterised by intermittent, severe, shooting pain in the face due to involvement of the trigeminal nerve.

Step 2: In about 95 percent of cases the cause is pressure on the trigeminal nerve close to where it enters the brainstem, just past the Gasserian ganglion. This compression is most often by an aberrant artery or vein, hence vascular compression is the most common cause.

Step 3: Other less frequent causes include tumour, cysts, arteriovenous malformation, and multiple sclerosis. Infection, trauma, and iatrogenic injury are not the usual cause, so option c is correct.

Step 4: First-line medical therapy is carbamazepine; gabapentin and valproate are alternatives.