What is the role of MRI in the workup of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Brain magnetic resonance imaging (MRI) with and without contrast helps to distinguish secondary causes of trigeminal neuralgia (TN) from the idiopathic form. This study is imaging modality of choice and indicated in patients presenting with trigeminal neuralgia when younger than 60 years, principally to exclude tumor. For example, MRI can reveal multiple sclerosis plaques and pontine gliomas. [22] Perform an MRI if atypical features are present. See the image below.

Magnetic resonance image (MRI) with high resolutio Magnetic resonance image (MRI) with high resolution on the pons demonstrating the trigeminal nerve root. In this case, the patient with trigeminal neuralgia has undergone gamma-knife therapy, and the left-sided treated nerve (arrow) is enhanced by gadolinium.

Some physicians recommend elective MRI for all patients to exclude an uncommon mass lesion or aberrant vessel compressing the nerve roots. However, in a published practice parameter, the American Academy of Neurology stated that because of inconsistency of studies, there was insufficient evidence to support or refute the usefulness of MRI or a specific MRI technique to identify vascular anomalies. [23] The recommendation was that, for patients with trigeminal neuralgia, routine imaging may be considered to identify symptomatic trigeminal neuralgia, and this was graded as a level C or possibly effective action. [23]

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