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Dolicho-vertebrobasilar abnormality and migraine-like attacks
C A Zambrino1, A Berardinelli, A Martelli
1Child Neuropsychiatry Division, 'C. Mondino Foundation' IRCCS, University of Pavia, Italy.mondino@cpbim1.unipv.it
Insights
This study investigates dolichobasilar anomaly in two children presenting with severe orbital pain. Findings suggest arterial malformations may compress the trigeminal nerve, causing these pain episodes.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Dolichobasilar anomaly is a rare vascular condition.
- Trigeminal neuralgia can manifest with severe facial pain.
- Magnetic resonance imaging (MRI) and angiography are key diagnostic tools.
Observation:
- Two pediatric cases with neuroradiologically diagnosed dolichobasilar anomaly were studied.
- Case 1: A 6-year-old experienced recurrent left orbital pain with photophobia and vomiting.
- Case 2: A 9-year-old with Marfan syndrome presented with similar nocturnal orbital pain, photophobia, and vomiting.
Findings:
- Diagnosis in both children was confirmed via MRI and magnetic resonance angiography.
- The intense, recurrent orbital pain attacks are hypothesized to result from trigeminal nerve compression.
- Arterial malformations associated with dolichobasilar anomaly are implicated as the cause of compression.
Implications:
- This study highlights a potential link between dolichobasilar anomaly and trigeminal nerve-related pain in children.
- Early diagnosis through advanced neuroimaging is crucial for managing such conditions.
- Understanding this association may improve diagnostic and treatment strategies for pediatric orbital pain.
Abstract:
This is a study of two children with neuroradiologically diagnosed dolichobasilar anomaly: in both cases, the diagnosis was based on magnetic resonance imaging and magnetic resonance angiography findings. We examined the first child (R., aged 6 years and 8 months) following four episodes of intense pain in the left orbit, lasting between 10 and 30 min and accompanied by photophobia and vomiting. The second child (S., aged 9 years and 2 months), suffering from Marfan's syndrome, was examined following recurrent episodes of intense pain that started above the left orbit, moving to the homolateral orbit after a few minutes. These episodes, which lasted between 20 and 30 min, took place mainly at night and were accompanied by phono-photophobia and vomiting. In both cases, the pain attacks can be interpreted as a result of compression of the root of the trigeminal nerve caused by an arterial malformation.