trigeminal neuralgia - Medical Dictionary

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trigeminal neuralgia		A syndrome characterized by recurrent episodes of excruciating pain lasting several seconds or longer in the sensory distribution of the trigeminal nerve. Pain may be initiated by stimulation of trigger points on the face, lips, or gums or by movement of facial muscles or chewing. Associated conditions include multiple sclerosis, vascular anomalies, aneurysms, and neoplasms. (Adams et al., Principles of Neurology, 6th ed, p187) [ Articles \| Books \| Images \| Discussion groups ]

Additional comments : (Tic Douloureux, Epileptiform Neuralgia, Fothergill Disease, Trifacial Neuralgia) Free Full Text Atypical facial pain--a diagnostic challenge Aust Fam Physician. 2005 Aug;34(8):641-5. BACKGROUND: Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners. Although in the vast majority of cases the cause is dental disease or tempero-mandibular joint dysfunction, the remaining patients are often difficult to diagnose and treat. OBJECTIVE: This article discusses the differential diagnosis of facial pain and presents three cases of atypical facial pain. DISCUSSION: A detailed history, clinical examination, imaging and laboratory investigations may be required to establish the cause of atypical facial pain. An assessment of the patient's mental state is mandatory, as depression or psychological overlay is common. In a small number of cases, the diagnosis remains unclear despite detailed investigation. These patients may have their symptoms ameliorated by empirical pharmacological therapy. Trigeminal neuralgia in a patient with multiple sclerosis and chronic inflammatory demyelinating polyneuropathy J Am Dent Assoc. 2005 Apr;136(4):469-76. BACKGROUND: Trigeminal neuralgia (TN) is characterized by unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Symptomatic or secondary TN involves TN-like pain that develops owing to a central nervous system lesion (benign or malignant) or to multiple sclerosis (MS). CASE DESCRIPTION: The authors present a report of a unique case of a 43-year-old patient with unilateral TN, MS and concomitant chronic inflammatory demyelinating polyneuropathy. The facial pain preceded any other manifestations of the systemic disorders, and only after repeated neurological examinations were these diagnoses established. CLINICAL IMPLICATIONS: Magnetic resonance imaging of the brain and repeated neurological evaluations should be implemented in all patients with TN to rule out the presence of underlying disease. The dental practitioner should be familiar with TN to avoid unnecessary dental interventions and ensure prompt initiation of appropriate treatment. Orofacial pain syndromes J Am Dent Assoc. 2005 Feb;136(2):142 Clinical study of patients with persistent orofacial pain Arq Neuropsiquiatr. 2004 Dec;62(4):988-96. OBJECTIVE: To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male). RESULTS: Patients were classified into three groups according to their presenting symptoms: a)Group I, eight patients (30.7%) with severe, diffuse pain at the face, teeth or head; b)Group II, eight patients (30.7%) with chronic non-myofascial pain and; c)Group III, ten patients with chronic myofascial pain (38.4%). We find 11 different diagnoses among the 26 patients: pulpitis(7), leukemia(1), oropharyngeal tumor(1), atypical odontalgia(1), Eagle's syndrome(1), trigeminal neuralgia(4), continuous neuralgia(1), temporomandibular disorders (9), fibromyalgia (2), tension-type headache(1), conversion hysteria(2). After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orofacial pain diagnosis (benign to life-threatening diseases) indicates the necessity to reevaluate patients presenting recurrent pain that is refractory to the usual treatments. Trigeminal neuralgia and glossopharyngeal neuralgia: two orofacial pain syndromes encountered by dentists J Am Dent Assoc. 2004 Oct;135(10):1427-33; quiz 1468. BACKGROUND: Dentists frequently evaluate patients for oropharyngeal pain that may or may not eventually be related to oral pathology. Two rare neurological disorders that present with severe orofacial pain are trigeminal neuralgia, or TN, and glossopharyngeal neuralgia, or GPN. Both are secondary to cranial nerve compression by arteries and veins at the point at which the nerves exit the pons and brainstem. RESULTS: The authors present the results for two series of patients treated for TN and GPN. Significant success can be seen after intracranial microvascular decompression for both disorders, with low complication rates. Short- and long-term outcomes depend on proper patient selection. CLINICAL IMPLICATIONS: It is important for practitioners to recognize these syndromes and properly refer patients to a neurosurgeon experienced in treating such disorders. This can help the dentist and patient avoid oral procedures that will not alleviate the painful symptoms. Use of the OxyArm in a patient suffering from trigeminal neuralgia Can J Anaesth. 2004 Feb;51(2):193-4. Treatment options for trigeminal neuralgia BMJ. 2003 Dec 13;327(7428):1360-1. Trigeminal neuralgia (Fothergill's disease) in the 17th and 18th centuries J Neurol Neurosurg Psychiatry. 2003 Dec;74(12):1688. Repeated peripheral nerve blocks by the co-administration of ketamine, morphine, and bupivacaine attenuate trigeminal neuralgia Can J Anaesth. 2003 Feb;50(2):201-2. Familial trigeminal neuralgia Neurol India. 2002 Mar;50(1):87-9. Familial trigeminal neuralgia is infrequent. A report of a couple and their son being afflicted by this malady is presented. The clinical features, radiological findings and surgical management are discussed and literature reviewed. Trigeminal neuralgia: pathology and pathogenesis Brain. 2001 Dec;124(Pt 12):2347-60. There is now persuasive evidence that trigeminal neuralgia is usually caused by demyelination of trigeminal sensory fibres within either the nerve root or, less commonly, the brainstem. In most cases, the trigeminal nerve root demyelination involves the proximal, CNS part of the root and results from compression by an overlying artery or vein. Other causes of trigeminal neuralgia in which demyelination is involved or implicated include multiple sclerosis and, probably, compressive space-occupying masses in the posterior fossa. Examination of trigeminal nerve roots from patients with compression of the nerve root by an overlying blood vessel has revealed focal demyelination in the region of compression, with close apposition of demyelinated axons and an absence of intervening glial processes. Similar foci of nerve root demyelination and juxtaposition of axons have been demonstrated in multiple sclerosis patients with trigeminal neuralgia. Experimental studies indicate that this anatomical arrangement favours the ectopic generation of spontaneous nerve impulses and their ephaptic conduction to adjacent fibres, and that spontaneous nerve activity is likely to be increased by the deformity associated with pulsatile vascular indentation. Decompression of the nerve root produces rapid relief of symptoms in most patients with vessel-associated trigeminal neuralgia, probably because the resulting separation of demyelinated axons and their release from focal distortion reduce the spontaneous generation of impulses and prevent their ephaptic spread. The role of remyelination in initial symptomatic recovery after decompression is unclear. However, remyelination may help to ensure that relief of symptoms is sustained after decompression of the nerve root and may also be responsible for the spontaneous remission of the neuralgia in some patients.

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