Arteriovenous Malformation Presenting as Trigeminal Neuralgia

Abstract

Case Report Past History. The patient first developed symptoms of right facial pain after a head injury in 1946, at the age of 29. Over the next 17 years, the pain became more persistent and debilitating despite various conservative measures. The pain was described by the patient as short-lived and shock-like. It was limited to the third division of the right fifth cranial nerve. In July, 1963, intracranial resection of the third division of the right trigeminal nerve was performed. The pain recurred. Reexploration and resection of the second and remaining fibers of the third division were carried out 2 weeks later. The patient remained free of pain for approximately 7 months, only to have recurrence of the neuralgia. On September 15, 1964, he underwent his third operation, a retrogasserian neurectomy. There was no recurrence of facial pain after this procedure. On June 21, 1965, while lifting a heavy weight at work, the patient became dizzy, complained of an excruciating headache, and had a generalized convulsion. He was admitted to another hospital in a semicomatose state. Neurological examination revealed a left hemiparesis and hemihypesthesia. Shortly after admission, pneumoencephalography demonstrated only moderate symmetrical dilatation of the lateral ventricles. The cerebrospinal fluid was grossly bloody and xanthochromic. He remained stuporous and confused for about 2 months. Despite a residual left hemiparesis and hemihypesthesia, he returned to full-time work as