Trigeminal neuralgia secondary to basilar invagination responsive to botulinum toxin type A. Case report
Neuralgia do trigêmeo secundária à invaginação basilar responsiva a toxina botulínica do tipo A. Relato de caso
João Vitor Andrade Fernandes; Raissa Nery de Luna Freire Leite; Adriana Meira Tiburtino Nepomuceno; Maurus Marques de Almeida Holanda; Alex Tiburtino Meira
Abstract
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia (TN) is a headache characterized by paroxysmal episodes of intense pain in the facial region. TN can occur secondary to structural mechanisms, such as vascular compression of the trigeminal nerve root. Basilar invagination (BI) is a malformation of the craniovertebral junction characterized by invagination of the odontoid process of the axis through the foramen magnum into the posterior fossa, and 1% of cases may present associated TN. This article presents a clinical case of TN secondary to BI and vascular compression of the trigeminal nerve root, which responded only to treatment with botulinum toxin type A.
CASE REPORT: A 34-year-old patient with a clinical presentation consistent with TN for approximately 12 years. The symptoms were debilitating and impacted the quality of life, culminating in constant insomnia, severe depression, and suicidal thoughts. Treatment with botulinum toxin type A was fundamental in managing this patient’s pain.
CONCLUSION: The case reported here demonstrated the therapeutic success of treatment with botulinum toxin type A in a complex and refractory case of pain syndrome.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: Neuralgia do trigêmeo (NT) é uma cefaleia caracterizada por episódios paroxísticos de dores intensas na região da face. A NT pode ocorrer secundariamente a mecanismos estruturais, como a compressão vascular da raiz do nervo trigêmeo. A invaginação basilar (IB) é uma má formação da junção craniovertebral caracterizada por invaginação do processo odontóide do Axis através do forâmen magno na fossa posterior, e 1% dos casos podem apresentar NT associada. Este artigo apresenta um caso clínico de NT secundária a IB e compressão vascular da raiz do nervo trigêmeo, que foi responsiva apenas ao tratamento com toxina botulínica tipo A.
RELATO DO CASO: Paciente do sexo masculino, 34 anos de idade com quadro clínico compatível com NT há aproximadamente 12 anos. Os sintomas eram debilitantes e impactavam na qualidade de vida, culminando em insônia constante, depressão grave e pensamentos suicidas. O tratamento com toxina botulínica tipo A foi fundamental no tratamento da dor deste paciente.
CONCLUSÃO: O caso reportado evidenciou o sucesso terapêutico do tratamento com toxina botulínica tipo A em um caso complexo e refratário de síndrome dolorosa.
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References
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Submitted date:
04/14/2024
Accepted date:
08/05/2024
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