1. Teaching NeuroImages Neurology Resident and Fellow Section
A 55-year female with recurrent short-lasting shock-like facial pain episodes
Teaching NeuroImages Neurology Resident and Fellow Section
Uniyal et al.
© 2013 American Academy of Neurology

2. Vignette
A 55-year female developed recurrent short-lasting shock-like pain involving left lower face.
Initiation of amlodipine for concurrent detection of hypertension relieved her of pain besides normalising her blood pressure.
Interestingly, occasions of non-compliance to amlodipine used to bring her pain back.
Uniyal et al.
© 2013 American Academy of Neurology

3. Cranial MRI with MR angiogram
Axial images Fast Imaging Employing Steady-state Acquisition sequence, showing left vertebral artery (white arrow) abutting antero-lateral medulla (A, B). MR angiogram, showing left vertebral artery (white arrow) taking narrower course compared to right vertebral artery (C). Anterior-inferior cerebellar artery loop (black arrow) is seen abutting left trigeminal nerve root (white arrow) (D-F). Another vascular loop is seen abutting the distal part of left trigeminal nerve root (curved white arrow) (E).
Uniyal et al.
© 2013 American Academy of Neurology

4. Amlodipine-responsive trigeminal neuralgia - An alibi for vascular compression theory
Her cranial MRI revealed tortuous blood vessels compressing left rostro-antero-lateral medulla and left trigeminal nerve root.
Vascular compression of medulla is known to produce neurogenic hypertension1 (Figure e-1).
Possibly, a decrease in vessel tortuosity2 mediated by voltage-gated L-type calcium channels (anti-hypertensive effect) and an action on N-type channels (sympathetic modulation/anti-nociceptive effect) played a role in amlodipine’s inadvertent efficacy (Figure e-2).
References:
Jannetta PJ, Segal RI, Wolfson Jr SK. Neurogenic hypertension: etiology and surgical treatment. I. Observations in 53 patients. Annals of surgery Mar;201(3):391.
Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain 2001;124:2347–2360.
Uniyal et al.
© 2013 American Academy of Neurology