Teaching NeuroImages: Amlodipine-responsive trigeminal neuralgia: An alibi for vascular compression theory

A 55-year-old woman developed recurrent short-lasting shock-like pain involving her left lower face. Initiation of amlodipine for concurrently detected hypertension relieved her of pain besides normalizing her blood pressure. Interestingly, occasions of noncompliance with amlodipine brought her pain back. Her cranial MRI revealed tortuous blood vessels compressing the left rostro-antero-lateral medulla and left trigeminal nerve root (figure 1). Vascular compression of medulla is known to produce neurogenic hypertension1 (figure e-1 at Neurology.org). Possibly, a decrease in vessel tortuosity2 mediated by voltage-gated L-type calcium channels (antihypertensive effect) and an action on N-type channels (sympathetic modulation/antinociceptive effect) played a role in amlodipine's inadvertent efficacy (figure e-2).
Source: Neurology - Category: Neurology Authors: Tags: MRI, Trigeminal neuralgia RESIDENT AND FELLOW SECTION Source Type: research