This study reports the first case of trigeminal neuralgia secondary to giant Virchow-Robin spaces and highlights advanced magnetic resonance imaging at 1.5 T to evaluate brainstem trigeminal pathways.
Virchow-Robin spaces are pial-lined, interstitial, fluid-filled structures that accompany penetrating arteries and arterioles as they enter the cerebral substance. Occasionally they may enlarge and become giant Virchow-Robin spaces (GVRS) and produce mass effect. Various neurological symptoms have been described in association with GVRS, however, trigeminal neuralgia has not yet been reported in this context. We present a case of trigeminal neuralgia secondary to dorsal pontine giant Virchow-Robin spaces (GVRS) and highlight the diagnostic radiologic features. Routine 1.5 T MRI sequences were sufficient to diagnose the GVRS and a diffusion tensor imaging (DTI) study revealed distortion of the intrinsic trigeminal pathway. This study highlights the utility of routine MRI to study the intrinsic anatomy of the trigeminal pathway in pathological conditions.
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aDivision of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
bDivision of Neuroradiology, University of British Columbia, Vancouver, British Columbia, Canada
*Corresponding author. Address: 8105-2775, Laurel Street, Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9. Tel.: +1 604 875 5894; fax: +1 604 875 4882.
Article history: Received 31 July 2012; Received in revised form 20 December 2012; Accepted 7 January 2013.