Introduction:

the intermediate nerve constitutes the sensory root of the facial nerve and was described by Wrisberg in 1777 as a separate branch. Among its functions are the control of salivary and lachrymal secretion, gustatory function and cutaneous sensitivity of parts of the external ear. Vertebrobasilar dolichoectasia is characterized by a dilated, elongated and tortuous vertebrobasilar complex.

Case report:

patient with headache of two months of evolution, referred to the region of the auricle and left external auditory canal, of sudden onset, duration of less than one minute, of electrical character and severe intensity according to visual analog scale. Neuralgia of the left intermediate nerve was suspected. A multi-slice tomography of the cranium-encephalon and magnetic resonance of the cranium-encephalon with angiography technique were performed. There was no evidence of intracranial space occupying lesion or in the auditory canal. There was evidence of elongated and distended vertebrobasilar complex, diagnosing vertebrobasilar dolichoectasia. Treatment with carbamazepine 600mg daily was started, resulting in total resolution of the painful crises.

Conclusions:

neuralgia of the intermediate nerve should be considered as differential diagnosis in patients with neuropathic pain referred to the external auditory canal region. Vertebrobasilar dolichoectasia was identified as the cause of neural compression. Pharmacological treatment constitutes the first line of treatment for these patients.

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