A giant internal carotid-posterior communicating artery aneurysm presenting with atypical trigeminal neuralgia and facial nerve palsy in a patient with autosomal dominant polycystic kidney disease: A case report

Citation
S. Terao et al., A giant internal carotid-posterior communicating artery aneurysm presenting with atypical trigeminal neuralgia and facial nerve palsy in a patient with autosomal dominant polycystic kidney disease: A case report, SURG NEUROL, 56(2), 2001, pp. 127-131
Citations number
17
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurology
Journal title
SURGICAL NEUROLOGY
ISSN journal
0090-3019 → ACNP
Volume
56
Issue
2
Year of publication
2001
Pages
127 - 131
Database
ISI
SICI code
0090-3019(200108)56:2<127:AGICCA>2.0.ZU;2-0
Abstract
BACKGROUND In cases of internal carotid-posterior communicating artery (IC- PC) aneurysm, involvement of the trigeminal nerve at its root is rare, and facial nerve palsy is even more unusual. CASE REPORT A large, unruptured IC-PC aneurysm was detected in a 56-year-ol d man with autosomal dominant polycystic kidney disease (ADPKD), but surger y was not performed because of mild renal dysfunction. Two months later, a sudden, severe headache suggested a subarachnoid hemorrhage, which was rule d out by computed tomography and lumbar puncture. Neurological examination revealed complete oculomotor palsy, atypical trigeminal neuralgia, and faci al palsy with gustatory disturbance. Magnetic resonance (MR) imaging reveal ed a partially thrombosed giant aneurysm that directly compressed the trige minal nerve root, reached the internal auditory canal, and was adjacent to the facial nerve. The neck of the aneurysm was successfully clipped via a s ubtemporal transtentorial approach. The postoperative course was uneventful , and all neurological symptoms had resolved within 3 months. CONCLUSIONS We believe that the prosopalgia in this case was atypical trige minal neuralgia due to direct compression of the trigeminal nerve root by t he aneurysmal sac. A contributory cause was stretching of the oculomotor ne rve, which contains sensory afferent inhibitory fibers derived from the oph thalmic branch of the trigeminal nerve. The facial palsy was of peripheral type and was accompanied by gustatory disturbance. This is the first report ed case of facial palsy caused by an IC-PC aneurysm and also a very rare ca se of an IC-PC aneurysm clipped by a subtemporal transtentorial approach. ( C) 2001 by Elsevier Science Inc.