Trigeminal (cranial nerve V) neuralgia and/or palsy is quite common. Damage to this nerve produces characteristic clinical manifestations, of which unilateral facial pain and/or atrophy of the masticator musculature is the most important. When these clinical features are recognized, the radiologist, armed with knowledge of the normal anatomy of the area, can focus on each segment of the nerve in search of a cause. The trigeminal nerve and its branches is divided into four segments: the intraaxial, cisternal, gasserian, and peripheral segments. Because each segment is usually affected by different disorders, localizing a lesion to a particular segment allows the radiologist to narrow the differential diagnosis. In this way, the most efficient imaging strategy for evaluation of the symptoms can be developed. Both computed tomography and magnetic resonance imaging are useful in assessing dysfunction of the trigeminal nerve; the choice depends on the status of the patient, the presumed site of the lesion on the basis of clinical findings, and the preference of the radiologist.
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