| 제목 | Trigeminal neuralgia is | ||
|---|---|---|---|
| Name | 관리자 | Date | 2014-07-02 |
내용
Trigeminal neuralgia is a disease where intense pain is experienced along the branches of the trigeminal nerve, the cranial nerve that is responsible for the senses of the face. The trigeminal nerve is divided to three branches, and trigeminal neuralgia usually occurs in 2 and 3, but can sometimes occur in 1.
How does the pain appear?
- It is a sharp, piercing pain like an electric shock.
- If one attack occurs, pain appears in one region of the face.
- The pain is spasmodic, and it continues as short as seconds to as long as minutes until it goes away naturally.
- Pain can occur repeatedly from few times to dozens of times a day..
- Washing the face, brushing teeth, eating, touching skin around the lips or the rounded sides of the nose,
talking, exposure to wind, and touching the hair can all trigger pain.
Cause and mechanism of trigeminal neuralgia?
Trigeminal neuralgia is classified as idiopathic trigeminal neuralgia and secondary trigeminal neuralgia depending on the cause.
- Idiopathic trigeminal neuralgia
In the case of idiopathic trigeminal neuralgia, like hemifacial spasm, most are caused by the demyelination of the trigeminal nerve due to the pressure of the blood vessels. - Secondary trigeminal neuralgia
In 5-8% of trigeminal neuralgia patients, damage of the trigeminal nerve due to another conditions such as brain tumor, cerebral aneurysm, multiple sclerosis, and inflammatory disease can cause pain.
Diagnosis and Tests
The most important thing is for a specialist to examine the clinical manifestations. The appearance of the pain and how long the disease had existed are examined and in order to determine any secondary cause, an MRI and MRA are done. It is especially important to examine the blood vessels and trigeminal nerve in the case of idiopathic trigeminal neuralgia.
One of the most important things is to compare other diseases that cause facial pain with trigeminal neuralgia.
One of the most important things is to compare other diseases that cause facial pain with trigeminal neuralgia.
Other diseases that cause facial pain
. Glossopharyngeal neuralgia
The frequency of this disease is much lower than trigeminal neuralgia, but it is very similar in many ways. The pain is intense and spasmodic, it occurs around the throat and tonsil, and pain can be triggered by swallowing, talking, chewing, yawning, and laughing hard. It can mostly be limited at the ear, but it can be emitted from the throat to the ear. Then it can be known that it has infiltrated the auricular region of the vagus nerve. There is facial neuralgia that accompany bradycardia or fainting in serious cases, it is thought that this is because pain stimulated the cardioinhibitory reflex arc. There is no known abnormality in sensation and movement. Rarely the abscess around the oropharyngeal-infracranial region or the tonsil region show pain that is hard to contrast with glossopharyngeal neuralgia clinically.
The frequency of this disease is much lower than trigeminal neuralgia, but it is very similar in many ways. The pain is intense and spasmodic, it occurs around the throat and tonsil, and pain can be triggered by swallowing, talking, chewing, yawning, and laughing hard. It can mostly be limited at the ear, but it can be emitted from the throat to the ear. Then it can be known that it has infiltrated the auricular region of the vagus nerve. There is facial neuralgia that accompany bradycardia or fainting in serious cases, it is thought that this is because pain stimulated the cardioinhibitory reflex arc. There is no known abnormality in sensation and movement. Rarely the abscess around the oropharyngeal-infracranial region or the tonsil region show pain that is hard to contrast with glossopharyngeal neuralgia clinically.
. Temporomandibular joint pain (Costen syndrome)
It occurs with one region of the temporomandibular joint functioning abnormally and causing facial pain. Malocclusion caused by dental wear that does not fit correctly or the loss of molars causes change of normal chewing motion, which then causes the transformation of the joints, and eventually the degenerative change that causes pain in the anterior region of the ear and referred pain in the temple and facial area. It also can sometimes be caused by rheumatoid arthritis. A diagnostic technique is to put the fingers on the external auditory canal and if the patient feels pain when the back of the joint is pressured forwardly, it is a pretty good indication of this disease. Also, tenderness around the joint, crepitus when the mouth is open, and limited ability to open the jaw are all indications of this disease. Dental treatment must be done first.
It occurs with one region of the temporomandibular joint functioning abnormally and causing facial pain. Malocclusion caused by dental wear that does not fit correctly or the loss of molars causes change of normal chewing motion, which then causes the transformation of the joints, and eventually the degenerative change that causes pain in the anterior region of the ear and referred pain in the temple and facial area. It also can sometimes be caused by rheumatoid arthritis. A diagnostic technique is to put the fingers on the external auditory canal and if the patient feels pain when the back of the joint is pressured forwardly, it is a pretty good indication of this disease. Also, tenderness around the joint, crepitus when the mouth is open, and limited ability to open the jaw are all indications of this disease. Dental treatment must be done first.
. Paratrigeminal syndrome (Raeder syndrome)
Clinically, pain and loss of sensation appears in branch 1 and 2 of the trigeminal nerve and paralysis of the sympathetic nerve such as blepharoptosis and miosis can occur in relation to the disease. In most cases, the ability to perspire in the lower region of the face remains normal. Nasopharyngeal cancer or granuloma occur commonly in relation to the disease.
Clinically, pain and loss of sensation appears in branch 1 and 2 of the trigeminal nerve and paralysis of the sympathetic nerve such as blepharoptosis and miosis can occur in relation to the disease. In most cases, the ability to perspire in the lower region of the face remains normal. Nasopharyngeal cancer or granuloma occur commonly in relation to the disease.
. Tolosa Hunt syndrome
Intermittent intense pain in the eye orbit occurs related to ocular motility disorder and loss of sensation in branch 1 of trigeminal nerve. Most are from the grauloma of the superior orbital fissure and cavernous sinus.
Intermittent intense pain in the eye orbit occurs related to ocular motility disorder and loss of sensation in branch 1 of trigeminal nerve. Most are from the grauloma of the superior orbital fissure and cavernous sinus.
. Neuralgia after Herpes Zoster
It is a clinical condition that comprises mainly of pain and rashes from herpes zoster that can sometimes invade the cornea. After these pain and rashes subside, postherpetic neuralgia usually occurs and the patient experiences very intense pain. Postherpetic neuralgia is known to appear regardless of the use of antiviral drug Acyclovir and does not easily heal completely even with surgical methods such as rhizotomy.
It is a clinical condition that comprises mainly of pain and rashes from herpes zoster that can sometimes invade the cornea. After these pain and rashes subside, postherpetic neuralgia usually occurs and the patient experiences very intense pain. Postherpetic neuralgia is known to appear regardless of the use of antiviral drug Acyclovir and does not easily heal completely even with surgical methods such as rhizotomy.
. Ramsay-Hunt Syndrome
This is a condition that occurs if the Herpes Zoster virus invades the geniculate ganglion. The patient experiences intense pain and paralysis of the facial muscle. Physically, the symptoms of Herpes Zoster are present and it is followed by deterioration of the facial muscles and oozing from the external ear. If the auditory nerves are invaded, loss of hearing can occur and all cranial nerves under the trigeminal nerves can be invaded. An antiviral drug called Acyclovir is used as treatment.
This is a condition that occurs if the Herpes Zoster virus invades the geniculate ganglion. The patient experiences intense pain and paralysis of the facial muscle. Physically, the symptoms of Herpes Zoster are present and it is followed by deterioration of the facial muscles and oozing from the external ear. If the auditory nerves are invaded, loss of hearing can occur and all cranial nerves under the trigeminal nerves can be invaded. An antiviral drug called Acyclovir is used as treatment.
. Cluster Headache
A pain similar to a migraine, a piercing pain along with headache occurs behind the eye. The duration of the pain is longer than what occurs in trigeminal neuralgia and it can occur from minutes to hours. It has a distinct symptom of nasal congestion and formation of tears where the pain is occurring. It can be differentiated from trigeminal neuralgia in that the pain is intense during the night and will even wake the patient. There are also no triggers to pain like there are in trigeminal neuralgia.
A pain similar to a migraine, a piercing pain along with headache occurs behind the eye. The duration of the pain is longer than what occurs in trigeminal neuralgia and it can occur from minutes to hours. It has a distinct symptom of nasal congestion and formation of tears where the pain is occurring. It can be differentiated from trigeminal neuralgia in that the pain is intense during the night and will even wake the patient. There are also no triggers to pain like there are in trigeminal neuralgia.
. Atypical facial pain
Excluding the aforementioned syndromes and pain in the throat, mouth, eyes, and the carotid artery, there are cases when the patient experiences facial pain, but cannot find the reason why. This mostly occurs in women, and intense pain in the face, nose, and other various regions occur. It is non-responsive to many kinds of pain-killers.
Excluding the aforementioned syndromes and pain in the throat, mouth, eyes, and the carotid artery, there are cases when the patient experiences facial pain, but cannot find the reason why. This mostly occurs in women, and intense pain in the face, nose, and other various regions occur. It is non-responsive to many kinds of pain-killers.
Although it is thought that mental or emotional reason or an abnormal personality could be related since a plausible reason cannot be found, very few patients qualify to be diagnosed as “hysteria.” However, depression to some extent is found in half of all patients. Whether the patient has depression or not, most patients are responsive to tricyclic antidepressant and monoamine oxidase (MAO) inhibitor.
Differentiation from trigeminal neuralgia is necessary and other reasons for this disease cannot be known. Like chronic pain, pain should be controlled for atypical facial pain as aforementioned and destructive brain surgery such as thalamotomy and limbic leucotomy should not be conducted.
Differentiation from trigeminal neuralgia is necessary and other reasons for this disease cannot be known. Like chronic pain, pain should be controlled for atypical facial pain as aforementioned and destructive brain surgery such as thalamotomy and limbic leucotomy should not be conducted.
