13.1.1.1.1 Classical trigeminal neuralgia, purely paroxysmal

Identification: Female patient, 62 years old, with episodes of right facial pain for 8 months. History of Present Illness: Pain: Location: Right V2 (maxillary) and V3 (mandibular) Characteristic: Paroxysmal ("electric shocks"), duration 1-15 seconds Excruciating intensity (10/10) Frequency: 20-30 episodes/day, clustered in bouts Specific triggers: Chewing (74% of episodes) Touching the upper lip ("trigger" area) Cold air Interictal periods: Completely asymptomatic No sensory deficits Relevant history: Controlled arterial hypertension No recent facial trauma or dental interventions Physical/Neurological Examination: Trigeminal assessment: Cutaneous trigger area: right upper lip (2mm²) Bilateral corneal reflex preserved Normal tactile and thermal sensitivity Provocative tests: Light brushing on the lip → typical episode reproduced Negative Valleix point compression General examination: No signs of multiple sclerosis or neurological deficits Complementary Exams: 3T MRI (FIESTA): Proximal neurovascular contact of the right trigeminal nerve: Superior cerebellar artery compressing the root entry zone (REZ) Demyelination signal in the proximal segment Trigeminal Evoked Potentials: Prolonged P19 latency on the affected side Diagnostic exclusion: Negative serology for syphilis/Lyme Normal blood glucose