 Corresponding author: Calixto Machado Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba. Copyright © 2022 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Trigeminal neuralgia secondary to medulla oblongata compression by vertebrobasilar dolichoectasia Jesús Pérez-Nellar 1 and Calixto Machado 2, * 1 Hermanos Ameijeiras Hospital, Service of Neurology, Havana, Cuba. 2 Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba. World Journal of Advanced Research and Reviews, 2022, 16(01), 784–787 Publication history: Received on 02 September 2022; revised on 25 October 2022; accepted on 28 October 2022 Article DOI: https://doi.org/10.30574/wjarr.2022.16.1.1005 Abstract Background. Trigeminal neuralgia secondary to medulla oblongata compression by dolichoectasia of the vertebral artery is rare. Case report. A 60-year-old patient with trigeminal neuralgia secondary to medulla oblongata compression by a dolichoectatic vertebral artery is presented. There was a remarkable improvement in the pain after treatment with Gabapentine. Conclusions. Direct involvement of the nerve is the usual mechanism of trigeminal neuralgia. However, medulla oblongata compression might be an important non-recognized mechanism in cases with vertebral dolichoectasia. Keywords: Trigeminal neuralgia; Medulla oblongata; Dolichoectasia; Vertebrobasilar; CT scan 1. Dear Editor Vertebrobasilar dolichoectasia is an uncommon vasculopathy of unclear etiology which affects the arterial wall of vertebral and/or basilar arteries.1 Patients with lesions in the dorsolateral medulla oblongata can develop facial pain2. However, to our knowledge, trigeminal neuralgia secondary to medulla oblongata compression by a dolichoectasia of the vertebral artery had not been reported previously. 2. Case report A 60-year-old male patient presented with a 2-year-history of severe lancinating pain in the distribution of the left second and third division of the trigeminal nerve. The pain came in sudden bursts that recurred many times during the day. Symptoms were exacerbated by talking, chewing, and shaving. The examination did not reveal any focal neurological deficit or sensory loss in the trigeminal nerve distribution, and the corneal reflex was normal. MRI was requested to identify a vascular loop or any other condition affecting the trigeminal nerve; however, the investigation revealed a notch of the left aspect of the medulla oblongata by an ecstatic vertebral artery (Figure 1). MRI excluded trigeminal nerve compression, so involvement of the sensory tracts in the medulla oblongata was the most plausible explanation for the pain.