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Trigeminal neuropathy: evaluation with MR imaging

C B Majoie1, B Verbeeten, J A Dol

  • 1Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|July 1, 1995
PubMed
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Trigeminal neuropathy affects the fifth cranial nerve. Magnetic resonance imaging (MRI) is crucial for diagnosing trigeminal nerve conditions by visualizing the entire nerve course.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Trigeminal nerve neuropathy can affect the nerve's entire pathway, from brainstem nuclei to peripheral branches.
  • Understanding the four segments of the trigeminal nerve—brain stem, cistern, Meckel cave/cavernous sinus, and extracranial—simplifies differential diagnosis.

Purpose of the Study:

  • To outline the differential diagnosis of trigeminal neuropathy based on lesion location.
  • To emphasize the role of magnetic resonance imaging (MRI) in diagnosing trigeminal nerve pathologies.

Main Methods:

  • Categorization of trigeminal nerve pathologies by anatomical location: brain stem, cisternal, Meckel cave/cavernous sinus, and extracranial.
  • Standard MRI protocol includes T2-weighted whole-brain images and high-resolution T1-weighted skull base images with and without contrast.

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Main Results:

  • Common brain stem causes include multiple sclerosis, infarcts, and gliomas.
  • Cisternal causes are often neurovascular compression, schwannomas, meningiomas, cysts, lipomas, and metastases.
  • Meckel cave/cavernous sinus pathologies include meningiomas, schwannomas, cysts, metastases, pituitary adenomas, and aneurysms.
  • Malignant tumors with perineural spread are the most frequent extracranial cause.

Conclusions:

  • Clinical findings alone are insufficient for accurate lesion localization in trigeminal neuropathy.
  • Comprehensive MRI is essential for visualizing the entire trigeminal nerve and establishing an accurate diagnosis.