A 79-year-old man presented with 7 years of brief episodes of lancinating left facial pain in the distribution of the first division of cranial nerve V. Despite taking carbamazepine, he continued feeling pain. Magnetic resonance imaging (MRI) (1.5 T) using spin-echo 6-mm axial noncontrast T1-weighted images and 2-mm axial 3-dimensional time-of-flight magnetic resonance angiography (MRA) were registered using consistent anatomic landmarks. The registered pseudocolor composite MRI/MRA axial image showed the left superior cerebellar artery coursing in close proximity across the root entry zone of cranial nerve V (Figure 1). The patient refused further intervention.
Bakshi R, Lerner A, Fritz JV, Sambuchi GD. Vascular Compression in Trigeminal Neuralgia Shown by Magnetic Resonance Imaging and Magnetic Resonance Angiography Image Registration. Arch Neurol. 2001;58(8):1290-1291. doi:10.1001/archneur.58.8.1290