A 60-year-old woman with a history of dyslipidemia and chronic tension-type headache presented in the last two months with episodes of left hemifacial pain of seconds duration, lancinating and third branch of the nerve.
Episodes are triggered mainly by facial friction, laughing or chewing, and after them a feeling of hypoesthesia and swelling remains in this location.
It can present up to three daily episodes.
He did not complain of headache, red eye, tear or rhinorrhea.
It is not accompanied by abnormal movements in this hemisphere.
She denied dysphagia or other symptoms.
On physical examination the patient is alert, oriented, collaborating, there is is isochory and normal pupillary reaction, eye movements are normal as well as the eye fundus.
The examination of the cranial nerves is normal except for hypoesthesia in the second and third branches of the left V p.c.
There is no dysphagia or language impairment.
There is no motor or sensory deficit associated with other levels.
Osteotendinous reflexes are present and symmetrical.
The rest of the neurological and general examination is normal.
Laboratory tests revealed hypercholesterolemia and hypertriglyceridemia.
In brain MRI enhanced at T1, T2 and FLAIR with sequences of fat suppression, there is an enlarged formation at the level of the petrous apex of 28 mm of posterior carotid artery flow, which is not compatible with the granulomatous tip.
In addition, empty bladder was detected as a casual finding.
After assessing the patient, symptomatic treatment was established with carbamazepine at a dose of 400 mg/day, with good response.
48 hours after the beginning of treatment the patient is asymptomatic, disappearing not only pain but also hypoesthesia, opting for conservative treatment.
