Identifying the anatomical structures involved in Anantavata – A Neuroimaging based clinical study

Abstract

Anantavata is recognized as a severe type of Tridoshaja Shiroroga.
Although the classical literature describes the complex manifestations of this disorder,
the anatomical and neuroanatomical substrates of this condition have not been
elaborated yet.
This study aimed at identifying the structural and neurovascular abnormalities
associated with Anantavata as per clinical presentations in patients diagnosed with
this condition using high resolution magnetic resonance imaging (MRI).
Methods: Cross-sectional observational study was conducted in 30 patients aged
between 18 and 70 years with typical clinical presentation of Anantavata. Severity of
Manya pida, Ghatasu ruja, Gandasya parshva kamp, Ashukari akshi/bhru pida, Shankha
desha pida, Hanugraha, and ophthalmic manifestations of this syndrome (Lochan rog)
was assessed using Visual Analogue Scale (VAS) and "Faces" Pain Rating Scale.
Structural and neurovascular abnormalities were identified using Magnetic resonance
imaging of the brain.
Results: Neurovascular conflict affecting the trigeminal nerve (5th cranial nerve) was
observed in the majority of the subjects examined. Abnormal cerebellar arterial loops
with impingement onto the trigeminal root entry zone accounted for the most
frequently observed structural abnormality (36.66%, n=11), with dolichoectasia of the
vertebrobasilar artery being the second (13.33%, n=4). Focal lesions of fat intensity in
the pontine region, extra-axial mass lesions in the cerebellopontine angle, and deep
white matter hyperintensities were found in 10%, 7%, and 23.33% (n=7) of patients,
respectively. No structural abnormalities were found in 23.33% (n=7) of the subjects.
Conclusion: The typical clinical presentation of Anantavata corresponds to the modern
concept of neurovascular compression syndromes including trigeminal and facial
nerves. MRI offers essential information regarding the structural pathogenesis of this
condition.