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Trigeminal Neuropathy

Isolated 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].

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]
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]
Trismus
  • Furthermore, there have been no detailed reports on occlusal abnormalities and trismus associated with post-traumatic trigeminal motor neuropathy.[ncbi.nlm.nih.gov]
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]
  • Our case suggests that treatment with interferon beta may also exacerbate symptomatic trigeminal neuralgia in multiple sclerosis.[ncbi.nlm.nih.gov]
  • Malignant trigeminal neuralgia due to perineural spread along the branches of the trigeminal nerve, is known to commonly occur secondary to squamous cell carcinomas, lymphomas and adenoid cystic carcinomas in the head and neck region.[ncbi.nlm.nih.gov]
  • Several randomized controlled trials in humans have provided emerging evidence for the therapeutic use of BTX-A in neuropathic pain states, including trigeminal neuralgia.[ncbi.nlm.nih.gov]
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]
Dystonia
  • Facial but not trigeminal neuropathy improved, and she developed a labial dystonia that only corrected while pressing the right medial incisor.[ncbi.nlm.nih.gov]

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]
  • No other pain-related or demographic parameters were associated with treatment outcome in the PTTN patients.[ncbi.nlm.nih.gov]
  • Treatment options are limited and often unsatisfactory due to insufficient efficacy and significant adverse effects.[ncbi.nlm.nih.gov]
  • Changes in quantitative sensory testing (QST) and the presence of dysesthesia as a treatment outcome were compared preoperatively and postoperatively in 10 patients. Two surgical treatments, bridging or encircling peripheral nerves, were applied.[ncbi.nlm.nih.gov]
  • PURPOSE: This study evaluated the use of images obtained by a dental computed tomography (CT) software program in the diagnosis and treatment of trigeminal neuropathy associated with jaw abnormality.[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]
  • Trigeminal neuropathy in systemic sclerosis was associated with a poor prognosis in 2 of the patients.[ncbi.nlm.nih.gov]
  • CONCLUSION: This study underpins the poor pharmacotherapeutic prognosis of PTTN. The results support findings on neuropathic pain in other sites and point to the need for further research and reexamination of current PTTN treatment protocols.[ncbi.nlm.nih.gov]
  • We used a PGA-c tube during surgery for trigeminal neuropathy and evaluated its prognosis based on the outcomes. DESIGN: Case report.[ncbi.nlm.nih.gov]
  • Article / Publication Details First-Page Preview Abstract The electroneuronographic registration of the summating potentials of the face muscles has been used to assess the prognosis in 72 traumatic facial nerve lesions.[karger.com]

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]
  • Complementary studies are needed to establish the etiologic diagnosis, with laboratory tests to discard the possible causative diseases underlying the trigeminal neuropathy, and the opportune radiographic examinations in the form of plain X-rays or a[ncbi.nlm.nih.gov]
  • Based on etiology and features, trigeminal pain following trauma was defined as "peripheral painful traumatic trigeminal neuropathy" (PPTTN). Data were analyzed with t tests, ANOVA, chi-square, and regression analyses.[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]
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]
  • Neurophysiologic tests and thermal QST provide sensitive tools for accurate diagnosis of trigeminal neuropathy and study of pathophysiological features characteristic to human neuropathic pain.[ncbi.nlm.nih.gov]
  • 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]
  • Diagnosis Although the diagnosis remains based exclusively on history and symptomatology, modern diagnostic techniques, particularly high-resolution magnetic resonance imaging, provides valuable new insight into the pathophysiology of these cases with[columbianeurosurgery.org]

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]
  • 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]
  • The neurosurgeon will make an incision behind the ear on the side that is causing pain, exposing the trigeminal nerve, then removes or relocates any blood vessels that are compressing the nerve or inserts a small pad to prevent contact with the nerve.[weillcornellbrainandspine.org]
  • Then we add a protective pad, usually made of shredded Teflon, or a sponge to protect the nerve and prevent recurrence. This treatment is not for everyone. It is most effective if you meet these criteria: Your pain is only on one side of your face.[mountsinai.org]

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