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Sphenopalatine Neuralgia

Neuralgia Sluder


Presentation

  • The authors present a patient with a 15-year history of sphenopalatine neuralgia who underwent stereotactic radiosurgery targeted at the sphenopalatine ganglion, with initial pain relief, and repeated radiosurgery 17 months later for partial pain recurrence[ncbi.nlm.nih.gov]
  • […] with unilateral facial pain that has been present for several years.[experts.umich.edu]
  • Argoff, MD and Gary McCleane, MD who present a thorough update on the latest in pain management. Presents a new contemporary internal design that helps you navigate the text easier.[books.google.com]
  • “We know that roughly 52 to 70 percent of patients with relapsing MS have cognitive issues and that these can present very early on,” said Dr. Hotermans.[practicalneurology.com]
Nasal Discharge
  • Two years following radiosurgery, the patient is pain free, no longer suffering from nasal discharge and eye irritation.[ncbi.nlm.nih.gov]
  • None of these patients have purulent nasal discharge or other features diagnostic of acute rhinosinusitis.[ncbi.nlm.nih.gov]
Lesion of the Tongue
  • I suffered from chronic mouth thrush (with creamy white lesions on my tongue and inner cheeks). My baby daughter had the same problem in her mouth and your program was the only thing that helped us![es.slideshare.net]
Flushing
  • SIGNS AND SYMPTOMS Conjunctival injection Excessive tearing Lacrimation Forehead/ facial sweating Rhinorrhea Ptosis Miosis Eyelid edema Red flushed face 15.[slideshare.net]
  • The needle is then flushed and withdrawn, and a band-aid is placed over the point of needle entry. Risks This procedure is safe. With any procedure, however, there are risks, side effects and possibility of complications.[centerforpain.com]
  • […] establish its aetiology; predominantly affects women of middle-age; a dull, unilateral pain in the orbit, temple, face, nasal fossa, radiating to the retroauricular and nuchal area; associated phenomena: hydrorrhoea, nasal stenosis, conjunctival hyperaemia, flushing[ncbi.nlm.nih.gov]
Eye Irritation
  • During attacks of pain, vasomotor activity often results in ipsilateral nasal drainage, eye irritation, and lacrimation.[ncbi.nlm.nih.gov]
  • During his attacks of pain, he describes unilateral nasal drainage, and ipsilateral eye irritation and lacrimation. He is not sure what causes his pain, and he is very upset with the lack of effective treatments thus far.[experts.umich.edu]
  • Also associated increased autonomic activity resulting in ipsilateral nasal drainage, eye irritation, and lacrimation May be caused by irritation of the pterygopalatine ganglion, possibly secondary to infection Typically female 2:1 male predominance Pittsburgh[en.wikibooks.org]
Excessive Tearing
  • SIGNS AND SYMPTOMS Conjunctival injection Excessive tearing Lacrimation Forehead/ facial sweating Rhinorrhea Ptosis Miosis Eyelid edema Red flushed face 15.[slideshare.net]
Eye Pain
  • pain; Idiopathic intracranial hypertension (pseudotumor cerebri); Cough, exertional, and sex headaches; The neck and headaches; Drug-induced headaches; Trigeminal neuralgia and glossopharyngeal neuralgia; Headaches and vasculitis; Tonsilar ectopia and[books.google.com]
Visual Hallucination
  • For centuries physicians and migraineurs have been fascinated by the visual hallucinations, or auras, which often precede a migraine and which are similar to those induced by hallucinogenic drugs or deliria.[books.google.com]
Facial Pain
  • Migraine headache Cluster headache (CH) Glossopharyngeal neuralgia Postherpetic neuralgia Atypical facial pain Sphenopalatine neuralgia. AB - A 38-year-old male presents with unilateral facial pain that has been present for several years.[experts.umich.edu]
  • It is characterized by some combination of sharp, stabbing, intense facial pain. Common symptoms reported by people with sphenopalatine neuralgia Reports may be affected by other conditions and/or medication side effects.[patientslikeme.com]
  • Complex Facial Pain Syndromes. Contemporary Neurosurgery , Vol. 28, Issue. 18, p. 1. CrossRef Google Scholar Siccoli, Massimiliano M Bassetti, Claudio L and Sándor, Peter S 2006. Facial pain: clinical differential diagnosis.[cambridge.org]
  • This article discusses Sluder's description and attempts to analyse its features in the light of current understanding of the different mechanisms and categories of facial pain.[ncbi.nlm.nih.gov]
  • The target will be a neural structure (sphenopalatine ganglion) which has an important role in facial pain. There have been a few trials trying to block this structure in trigeminal neuralgia, but none using this new approach with botulinum toxin.[centerwatch.com]
Unilateral Facial Pain
  • facial pain that has been present for several years.[experts.umich.edu]
  • Background: TN is a disabling condition manifesting as severe, often unilateral facial pain paroxysms precipitated by various non-noxious stimuli.[n.neurology.org]
Irritability
  • During attacks of pain, vasomotor activity often results in ipsilateral nasal drainage, eye irritation, and lacrimation.[ncbi.nlm.nih.gov]
  • Also associated increased autonomic activity resulting in ipsilateral nasal drainage, eye irritation, and lacrimation May be caused by irritation of the pterygopalatine ganglion, possibly secondary to infection Typically female 2:1 male predominance Pittsburgh[en.wikibooks.org]
  • During his attacks of pain, he describes unilateral nasal drainage, and ipsilateral eye irritation and lacrimation. He is not sure what causes his pain, and he is very upset with the lack of effective treatments thus far.[experts.umich.edu]
  • While it was attributed to irritation of the sphenopalatine ganglion, it is not regarded as a disease a sui generis and has been subsumed under cluster headache.[medical-dictionary.thefreedictionary.com]

Treatment

  • In reports claiming cures with treatment directed at the ganglion the duration of post-treatment follow-up has been short.[ncbi.nlm.nih.gov]
  • The researchers believe that this treatment can become a "low threshold"-treatment for patients who do not have enough effect with pharmacological treatment and a better alternative to other complex surgical approaches.[centerwatch.com]
  • He is not sure what causes his pain, and he is very upset with the lack of effective treatments thus far. He would like to know his diagnosis and treatment options. He has never been treated with any prescription medications other than opioids.[experts.umich.edu]
  • Hence, non-invasive SPG block might be an attractive and effective treatment modality for these difficult-to-treat patients. Through its neural connection to the trigeminal sensory branches, the SPG represents a promising treatment target.[n.neurology.org]
  • Dihydroergotamine (DHE) • Can be used here also • Best given intravenously . • Typically relieves pain in 1-2 days of repetitive treatment; pain may not return for days to months which allows time for a preventive(s) to become effective. 24. 3.[slideshare.net]

Prognosis

  • Outlook (Prognosis) • Cluster headaches are not life threatening and usually cause no permanent changes to the brain. • However, they are chronic and often painful enough to interfere with work or lifestyle. • Rarely, the pain may be so severe that some[slideshare.net]

Etiology

  • The secondary headaches include a diverse and fascinating array of etiologies which can mimic primary headache disorders ranging from the rare to the mundane and from the well established to the highly controversial.[books.google.com]
  • ETIOLOGY • The exact cause is not yet known. • However, evidence strongly suggests that abnormalities in the hypothalamus may play a major role in cluster headaches. • Also related to the body's sudden release of histamine (chemical in the body released[slideshare.net]
  • […] the most frequent form of TN with defined etiology.[n.neurology.org]
  • Jannetta, PJ : Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia: Definitive microsurgical treatment and results in 117 patients.[journals.sagepub.com]

Epidemiology

  • Epidemiology, clinical diagnosis, pathophysiology, outcome measurement and the best evidence-based management of individual and general neuropathic pain conditions are also described in depth.[books.google.com]
  • Vågå study of headache epidemiology. Cephalalgia. 2005;25(4):296–304. 2. Caminero AB, Pareja JA. Supraorbital neuralgia: A clinical study. Cephalalgia. 2001;21(3):216–223. 3. Asensio-Samper JM, Villanueva VL, Pérez AV, et al.[dovepress.com]
  • […] edit ] The vasoconstrictor ergot compounds may be useful, [9] but have not been well studied in acute attacks. [53] Octreotide administered subcutaneously has been demonstrated to be more effective than placebo for the treatment of acute attacks. [58] Epidemiology[en.wikipedia.org]
  • This has led to greater epidemiological and nosographic awareness of headaches, which has been accompanied by the accumulation of valid suggestions on the need for a revised second edition.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Epidemiology, clinical diagnosis, pathophysiology, outcome measurement and the best evidence-based management of individual and general neuropathic pain conditions are also described in depth.[books.google.com]
  • A review of pathophysiology. Acta Neurochir (Wien) 113: 24 – 30, 1991. Google Scholar 21. Nishihara, K, Hanakita, J: Three cases of Eagle's syndrome. No Shinkei Geka 3 ( Suppl ): 441 – 445, 1986. Google Scholar 22.[journals.sagepub.com]

Prevention

  • Transitional therapy • Short-term preventive treatment that bridges the time between cluster diagnosis and when a true preventive agent becomes effective. • When the transitional agent is tapered off (typically in one to two weeks) the maintenance preventive[slideshare.net]
  • Jorge Serrador, a cardiovascular electronics researcher, vasoconstriction, such as that in sphenopalatine ganglioneuralgia, is probably a defense mechanism to ensure that abrupt changes in temperature in the brain are prevented, and thus kept warm.[biology-online.org]
  • You can also try preventing brain freeze by taking a sip of a warmer beverage immediately before and after the cold beverage in order to keep the nerves warm.[healthline.com]
  • The pharmacologic management may be divided into abortive/symptomatic and preventive/prophylactic strategies.[medhelp.org]
  • Once applied, the SPG block can relieve headache pain instantly and prevent future attacks. SphenoCath provides most patients with immediate relief of pain from headaches, craniofacial pain, facial pain, migraines or trigeminal neuralgia.[amimaging.com]

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