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Trigeminal Nerve Lesion

Trigeminal Neuropathy

Trigeminal neuropathy is a condition characterized by a specific pattern and location of facial pain. Clinical features involve unilateral and paroxysmal attacks of very intense pain in one or more areas innervated by the trigeminal nerve. The pathogenesis is frequently unclear and the vast majority of cases remain idiopathic. A thorough patient history and a physical examination are crucial steps of the workup, whereas imaging studies and neurophysiological testing are often necessary to solidify the diagnosis.


Presentation

Trigeminal neuropathy is an important neuropathic disorder that can have a considerable impact on the quality of life [1] [2] [3]. This condition is often regarded as idiopathic, although vascular compression of the trigeminal nerve seems to be the most probable cause in the majority of patients [3] [4]. Tumors and demyelinating diseases (for example multiple sclerosis) have been described as potential etiologies as well [3] [4]. The main symptom of this condition, namely facial pain, stems from the irritation of the trigeminal nerve and its branches - ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves [1] [4] [5] [6]. The pain is characterized as stabbing, superficial, electric shock-like, sharp, or intense pain, and regarded as a very debilitating condition [1] [4] [6]. It is virtually always unilateral, but isolated reports show that bilateral occurrence has been encountered in about 30% of multiple sclerosis patients affected by trigeminal neuropathy [2]. The onset is paroxysmal, lasting seconds to minutes, and is often precipitated by a seemingly benign event, such as a light touch, on the affected side of the face [1] [4] [5]. One or more divisions of the trigeminal nerve are involved while the pain never spreads to parts of the head and neck which are not innervated by the trigeminal nerve [1] [2] [4] [5].

Spontaneous Hemorrhage
  • Such cases are rare and should be evaluated using serial MR imaging to differentiate angiographically occult vascular malformation from spontaneous hemorrhage.[ncbi.nlm.nih.gov]
Pain
  • pain (painful temporomandibular disorder).[ncbi.nlm.nih.gov]
  • The pain is characterized as stabbing, superficial, electric shock-like, sharp, or intense pain, and regarded as a very debilitating condition.[symptoma.com]
Swelling
  • Fluorophotometry showed no evidence of increased endothelial permeability during corneal swelling in the left eye.[ncbi.nlm.nih.gov]
Constitutional Symptom
  • In the present case report, of a plasmacellular type localized within the mesenterium, a 25-year-old woman exhibited a clinical picture of right trigeminal neuropathy (together with more common constitutional symptoms and laboratory findings), which promptly[ncbi.nlm.nih.gov]
Hand Pain
  • OBJECTIVE: Although surgery using a polyglycolic acid-collagen (PGA-c) tube is effective for peripheral nerve injury-induced chronic hand pain, it has not been applied to trigeminal nerve lesions because of the difficult approach.[ncbi.nlm.nih.gov]
Amyloidosis
  • There was no evidence of systemic amyloidosis or underlying inflammatory or neoplastic disorders. Her blink reflex and thin-slice magnetic resonance imaging demonstrated that the right trigeminal nerve was involved.[ncbi.nlm.nih.gov]
Trismus
  • Furthermore, there have been no detailed reports on occlusal abnormalities and trismus associated with post-traumatic trigeminal motor neuropathy.[ncbi.nlm.nih.gov]
Numb Chin Syndrome
  • Not surprisingly, many different names have been used, including chronic injury–induced orofacial pain, anesthesia dolorosa, posttraumatic neuralgia or neuropathy, secondary trigeminal neuralgia from facial trauma, neuropathic orofacial pain, numb chin[quintpub.com]
Neuralgia
  • Trigeminal neuropathy and neuralgia are most commonly caused by vascular compression. Only 9 cases of trigeminal neuropathy and neuralgia due to pontine infarction have been reported in medical literature.[ncbi.nlm.nih.gov]
  • Conditions not covered by these SOPs Classical trigeminal neuralgia* (trigeminal neuralgia) Cluster headache* Glossopharyngeal neuralgia # Herpetic neuralgia # - That is pain at the time of the infection (Herpes Zoster) Migraine* Neuropathy in other cranial[clik.dva.gov.au]
Trigeminal Neuralgia
  • Cases 1 and 2 had trigeminal neuralgia, which had previously been incorrectly attributed to osteoma and maxillary sinus retention cyst, respectively, and resulted in inappropriate dental surgical procedures.[ncbi.nlm.nih.gov]
  • neuralgia* (trigeminal neuralgia) Tic Douloureux* (trigeminal neuralgia) Trigeminal neuralgia* * another SOP applies - the SOP has the same name unless otherwise specified Clinical onset The clinical onset is the earliest time prior to the confirmation[clik.dva.gov.au]
Cranial Nerve Involvement
  • Cranial nerve involvement in patients with leprous neuropathy. Neurol India 2006; 54: 283–285. Sumner CJ and Fischbeck KH. Jaw drop in Kennedy’s disease. Neurology 2002; 59: 1471–1472.[oasisdiscussions.ca]
  • Group 1 involved patients such as those described above with oculosympathetic paresis and trigeminal and potentially other cranial nerve involvement.[medlink.com]
  • Severe dysphagia in lower cranial nerve involvement as the initial symptom of Wegener's granulomatosis. Journal of the Neurological Sciences. 2007; 263 (1-2):187–190. [ PubMed ] [ Google Scholar ] 112. Pamuk ON, Doğutan H, Pamuk GE, Cakir N.[ncbi.nlm.nih.gov]
  • Less often, diabetic patients may develop focal and multifocal neuropathy that includes cranial nerve involvement, limb and truncal neuropathies.[scielo.br]
Hyperalgesia
  • These patients often present with complex changes of facial sensibility in the form of dysesthesia, hyperalgesia, and allodynia.[ncbi.nlm.nih.gov]
  • Diagnostic criteria: Facial and/or oral pain in the distribution(s) of one or both trigeminal nerve(s) and fulfilling criterion C History of an identifiable traumatic event 1 to the trigeminal nerve(s), with clinically evident positive (hyperalgesia,[ichd-3.org]
  • Clinically evident positive (hyperalgesia, allodynia) and/or negative (hypoesthesia, hypoalgesia) signs of trigeminalnerve dysfunction D.[quintpub.com]
Hyperesthesia
  • A 27-year-old woman with bruxism suffered a spider bite (Loxosceles rufescens) on the left cheek that caused severe local cellulitis, facial palsy, and painful hyperesthesia over the two lower trigeminal nerve divisions.[ncbi.nlm.nih.gov]
  • Secondary vs idiopathic trigeminal neuralgia Symptomatic or secondary trigeminal neuralgia is a more likely consideration than the idiopathic form when pain is associated with hyperesthesia along the course of the fifth nerve or is observed with other[emedicine.medscape.com]

Workup

The diagnostic workup of patients in whom trigeminal neuropathy is suspected should start with a comprehensive patient history during which the physician must cover the duration of symptoms and the characteristics of pain, including its pattern of occurrence as well as severity and location [4] [6] [7]. Together with the obtained information, the physical examination can provide important clues to the etiology of the disease. Reduced sensitivity of the trigeminal branches, either partial or total (hypoesthesia and anesthesia, respectively), during the neurological examination is a crucial finding in this patient population and should prompt a more detailed investigation [5]. Imaging studies, mainly magnetic resonance imaging (MRI), are highly useful in recognizing an ongoing process in the brain that could induce trigeminal neuropathy [1] [2] [4] [6]. MRI is particularly useful for detecting vascular malformations that compress the trigeminal nerve and currently serves as a gold-standard for the examination of craniofacial pain [1]. Some authors recommend X-rays and computed tomography (CT) scans to exclude other, more common, pathologies [4] [5]. In addition, neurophysiological trigeminal reflex testing has shown to be equally effective compared to MRI in identifying trigeminal neuropathy [2] [7].

Treatment

  • Worsening of primary headache disorders by interferon treatment has been previously reported. Our case suggests that treatment with interferon beta may also exacerbate symptomatic trigeminal neuralgia in multiple sclerosis.[ncbi.nlm.nih.gov]

Prognosis

  • The lesions underlying neoplastic trigeminal neuropathy can be located at any point along the trajectory of the trigeminal nerve, and their prognosis is very poor. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Prognosis The condition tends to come and go. Attacks of pain may be experienced off and on all day, or for days or weeks at a time, or no pain may be experienced for a prolonged period of time. However in most cases, the prognosis is good.[brainfoundation.org.au]

Etiology

  • Tumors and demyelinating diseases (for example multiple sclerosis) have been described as potential etiologies as well.[symptoma.com]
  • We review the spectrum of etiologies underlying both painful and non-painful trigeminal neuropathies, with attention to particularly dangerous processes that may elude the clinician in the absence of a meticulous evaluation.[ncbi.nlm.nih.gov]
  • A study of etiology with emphasis on dental causes. JAMA 1963; 184: 458–462. Jefferson G and Schorstein J. Injuries of the trigeminal nerve, its ganglion and its divisions. Br J Surg 1955; 42: 561–581. Graff-Radford SB and Evans RW.[oasisdiscussions.ca]

Epidemiology

  • Epidemiology of typical and atypical craniofacial neuralgias. Neurological Sciences. 2005 May 1;26(2):s65-7. Rushton JG, Olafson RA. Trigeminal neuralgia associated with multiple sclerosis: report of 35 cases.[physio-pedia.com]
  • PROXIMAL DIABETIC NEUROPATHY (PDN) OF THE LOWER LIMBS Clinical and epidemiological aspects – Diabetic patients, usually over the age of 50, may present proximal neuropathy of the lower limbs characterized by a variable degree of pain and sensory loss[scielo.br]
  • Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982–2003. Rheumatology. 2006; 45 (2):187–191. [ PubMed ] [ Google Scholar ] 103. Westhoff G, Zink A. Epidemiology of primary Sjörgren's syndrome.[ncbi.nlm.nih.gov]
  • Epidemiology of typical and atypical craniofacial neuralgias. Neurological Sciences 2005;26 Suppl 2:s65-67. Summary Putzki N et al. Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis.[mstrust.org.uk]
  • Another case report of trigeminal neuralgia was reported in a patient with spontaneous intracranial hypotension; both conditions resolved following surgical treatment of a cervical root sleeve dural defect. [9] Epidemiology In 1968, Penman reported the[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Painful posttraumatic trigeminal neuropathy (PPTTN) is a chronic condition that is difficult to endure and has a poorly understood pathophysiology.[ncbi.nlm.nih.gov]
  • Nor is it clear whether the two diseases are distinct entities or share common pathophysiological mechanisms.[bmcneurol.biomedcentral.com]
  • The pain may manifest in any of many distinct forms that are believed to reflect differences in neural pathophysiologies, even if the details are not well known.[ichd-3.org]
  • A spectrum of pathophysiological processes may affect the trigeminal nerves, including traumatic, vascular, inflammatory, demyelinating, infectious, and neoplastic disorders.[oasisdiscussions.ca]

Prevention

  • Doctors do not know how to prevent trigeminal neuralgia, to predict who will get it, or determine who will respond to a particular treatment until it is tried.[emedicinehealth.com]
  • Prevention There are no guidelines for preventing the development of trigeminal neuralgia.[medicalnewstoday.com]
  • There are several different methods that can be used: Radiofrequency Ablation (RFA) – Radio waves are applied to a nerve or plexus, preventing the transmission of pain.[ainsworthinstitute.com]
  • The surgeon locates the blood vessel that is pushing against the trigeminal nerve, causing the pain, and inserts a pad between the nerve and the blood vessel to prevent any further contact.[pabrainspine.com]

References

Article

  1. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220-228.
  2. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289-299.
  3. McMillan R. Trigeminal Neuralgia — A Debilitating Facial Pain. Rev Pain. 2011;5(1):26-34.
  4. Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007;334(7586):201-205.
  5. Peñarrocha M, Cervelló MA, Martí E, Bagán JV. Trigeminal neuropathy. Oral Dis. 2007;13(2):141-150.
  6. Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia: The pharmacological and surgical options. Neurosciences (Riyadh). 2015;20(2):107-114.
  7. Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010;3(2):107-115.

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Last updated: 2019-07-11 20:57