13.1.1.1.2 Classical trigeminal neuralgia with concomitant continuous pain

Identification: Male patient, 58 years old, with a history of left facial pain for 1 year. History of Present Illness: Paroxysmal component: Location: Left V2 (maxillary) Characteristic: Electric shocks (intensity 10/10), duration 5-20 seconds Frequency: 15-20 episodes/day Triggers: Chewing, brushing teeth, cold wind Continuous component: Location: Left infraorbital region Characteristic: Constant burning (intensity 4-6/10) No completely asymptomatic periods Worsens at night Relevant history: Arterial hypertension Smoking (30 pack-years) Physical/Neurological Examination: Trigeminal assessment: Trigger area: Left nasal ala (3mm²) Mild hypoesthesia in V2 (von Frey brush 3.61) Decreased ipsilateral corneal reflex Provocative tests: Light touch on the nasal filter → paroxysmal crisis Mechanical hyperalgesia in the infraorbital region General examination: No other neurological deficits Complementary Exams: 3T MRI (FIESTA/CISS): Superior cerebellar artery compressing the trigeminal root (entry zone) Hyperintense signal in the proximal portion of the nerve (suggesting demyelination) Electrophysiology: Trigeminal evoked potentials with increased latency (N13-P19) Diagnostic exclusion: Serologies for infectious diseases negative Blood glucose and lipid profile normal