Management of Uncommon Secondary Trigeminal neuralgia related to a rare Arnold Chiari type I malformation

Zafar Ali Khan, Ammar Ahmed Siddiqui, Jamaluddin Syed, Andrea Cicconetti, Alessandro Orefici, Giovanni Falisi, Francesca Fabiano, Luigi Santacroce, Patrizio Bollero, Francesco Inchingolo


Trigeminal neuralgia (TN) may sometimes present secondary to an intra-cranial cause. Arnold Chiari Malformation (ACM) is downward herniation of the cerebellar tonsils through the foramen magnum that may be a cause of TN like pain in very rare cases.

The aim of this brief report is to suggest the proper management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation.

A male patient presented electric shock like stabbing pain on the right side of the face for more than ten years. The symptoms were typical of trigeminal neuralgia except that there was loss of corneal reflex on the right side and the patient also complained of gait & sleep disturbances. Complex and multilevel diagnosis was made.

A multiplanar imaging through brain acquiring T1/T2W1 revealed ACM Type I Malformation with caudal displacement of cerebellar tonsils through foramen magnum.

Dental surgeons and oral and Maxillofacial Surgeons should exclude intra-cranial causes by Magnetic Resonance Imaging(MRI) in patients of TN presenting with loss of corneal reflex, gait and sleep disturbances due to night time pain episodes.
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