-
Acta Neurologica Scandinavica Nov 2022Stroke is a leading cause of death and disability. Some patients may present with atypical symptoms. One of the very rare presentations of stroke is initial neurogenic... (Review)
Review
Stroke is a leading cause of death and disability. Some patients may present with atypical symptoms. One of the very rare presentations of stroke is initial neurogenic pain. Rare painful presentations include, amongst others, acute trigeminal neuralgia, atypical facial pain, hemi-sensory pain, and episodic pain. Based on the available literature, the pain at presentation may be episodic, transient, or persistent, and it may herald other debilitating stroke symptoms such as hemiparesis. Pain quality is often described as burning; less often as sharp. Patients often have accompanying focal symptoms and findings on neurological examination. However, in several of the reviewed cases, these were discrete or non-existent. In patients with pain located in the trunk and/or extremities, lesions may involve the thalamus, lateral medulla oblongata, insula, or parietal lobe. In patients with atypical facial or orbital pain (including the burning "salt and pepper" sensation), the stroke lesions are typically located in the pons. In this narrative review, we included studies/case series of patients who had pain at the time of onset, shortly before or within 24 h of stroke symptoms (on the day of admission). Cases with pain related to aortic or cervical vessel dissection, cerebral venous sinus thrombosis, subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and CNS vasculitis were excluded. With this review, we aim to summarize the current knowledge on stroke presenting with acute pain.
Topics: Cerebrovascular Disorders; Facial Pain; Humans; Stroke; Subarachnoid Hemorrhage; Trigeminal Neuralgia
PubMed: 35788546
DOI: 10.1111/ane.13666 -
Praxis 2022
Topics: Humans; Trigeminal Neuralgia
PubMed: 36221973
DOI: 10.1024/1661-8157/a003917 -
Journal of Korean Neurosurgical Society Sep 2022Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a...
Various treatments for trigeminal neuralgia (TN) are known to yield initial satisfactory results; however, the surgical treatment has excellent long-term outcomes and a low recurrence rate. Surgical treatment addresses the challenge of vascular compression, which accounts for 85% of the causes of TN. As for surgical treatment for TN, microvascular decompression (MVD) has become the surgical treatment of choice after Peter J. Jannetta reported the results of MVD surgery in 1996. Since then, many studies have reported a success rate of over 90% for the initial surgical treatment. Most MVDs aim to separate (decompress) the culprit vessel from the trigeminal nerve. To increase the success rate of surgery, accurate indications for MVD and management of the offender vessels without complications are critical. In addition, if there is no vascular compression, partial sensory rhizotomy or internal neurolysis can be performed to improve surgical outcomes.
PubMed: 35430788
DOI: 10.3340/jkns.2021.0265 -
Acta Neurochirurgica May 2024Based on a personal experience of 4200 surgeries, radiofrequency thermocoagulation is useful lesional treatment for those trigeminal neuralgias (TNs) not amenable to... (Review)
Review
Based on a personal experience of 4200 surgeries, radiofrequency thermocoagulation is useful lesional treatment for those trigeminal neuralgias (TNs) not amenable to microvascular decompression (idiopathic or secondary TNs). Introduced through the foramen ovale, behind the trigemnial ganglion in the triangular plexus, the needle is navigated by radiology and neurophysiological testing to target the retrogasserian fibers corresponding to the trigger zone. Heating to 55-75 °C can achieve hypoesthesia without anaesthesia dolorosa if properly controlled. Depth of anaesthesia varies dynamically sedation for cannulation and lesioning, and awareness during neurophysiologic navigation. Proper technique ensures long-lasting results in more than 75% of patients.
Topics: Trigeminal Neuralgia; Humans; Electrocoagulation; Trigeminal Nerve; Foramen Ovale; Trigeminal Ganglion; Microvascular Decompression Surgery; Treatment Outcome
PubMed: 38727725
DOI: 10.1007/s00701-024-06074-2 -
Cleveland Clinic Journal of Medicine Jun 2023Guidelines for the diagnosis and treatment of patients with trigeminal neuralgia (TN) advocate for a multidisciplinary team approach to improve the care of patients with...
Guidelines for the diagnosis and treatment of patients with trigeminal neuralgia (TN) advocate for a multidisciplinary team approach to improve the care of patients with acute and chronic TN. Evidence-based discussions and decisions are encouraged to establish care pathways for prompt diagnosis and treatment, and long-term outcomes data collection to improve care. The guidelines include summary materials for patients to inform them about their condition and available treatments.
Topics: Humans; Trigeminal Neuralgia; Pain Management; Treatment Outcome
PubMed: 37263669
DOI: 10.3949/ccjm.90a.22052 -
Psychiatria Danubina Dec 2019In this paper the authors present neuroanatomical and neurophysiological arguments against the microvascular compression in the root entry zone of trigeminal nerve nerve... (Review)
Review
In this paper the authors present neuroanatomical and neurophysiological arguments against the microvascular compression in the root entry zone of trigeminal nerve nerve as an ethiopathogenetic factor of ITN. Clinical experience has proven that compression of mixed sensorymotor nerve (peripheral or central one), cannot provoke paroxysmal neuralgic pain. The authors conclude that the well known fact that dental pulp has only pain sensory modality brings up the question what might be consequence of tooth extraction where neural fibers are broken in the innervation areas of maxillar and mandibular nerve. The answer could be only one. If exclusive algophoric deafferentation hypersensitivity after tooth extraction exceeds a certain threshold, patients will experience paroxysmal neuralgic pain. Broken neural fibers develop pathological ephaptic communication with other trigeminal sensory modalities through supraspinal central structures responsible for the transmision of dental pulp pain. This can explain trigger phenomena and latency between the touching of circumoral areas and onset of neuralgic paroxysm, which is a central epileptic phenomenon. In conclusion, the so-called idiopathic trigeminal neuralgia (ITN) is the expression of algophoric deafferentation hypersensitivity after tooth extraction.
Topics: Humans; Pain; Trigeminal Neuralgia
PubMed: 32160164
DOI: No ID Found -
Neurology India 2022
Topics: Follow-Up Studies; Humans; Radiosurgery; Treatment Outcome; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 35864606
DOI: 10.4103/0028-3886.349723 -
Neurology India 2022The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are... (Review)
Review
BACKGROUND
The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN. Their management and surgical outcomes remain poorly understood.
OBJECTIVES
To perform a systematic review of clinical presentation and surgical outcomes of middle fossa defects presenting with trigeminal nerve-related symptoms.
MATERIALS AND METHODS
A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management, and outcomes are discussed and illustrated with a case.
RESULTS
Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. "Empty sella" syndrome and radiologic signs of intracranial hypertension were present in 40%-62%. No patient presented with cerebrospinal fluid leak. The preferred treatment modality was surgical with subtemporal extradural repairs using combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases, and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.
CONCLUSIONS
MEC containing prolapsed trigeminal nerve rootlets can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective, and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
Topics: Cranial Fossa, Middle; Dura Mater; Encephalocele; Female; Humans; Male; Meningocele; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 35864609
DOI: 10.4103/0028-3886.349629 -
The Journal of Headache and Pain Nov 2022Excruciating trigeminal neuralgia (TN) management is very difficult and severely affects the patient's quality of life. Earlier studies have shown that the trigeminal... (Review)
Review
Excruciating trigeminal neuralgia (TN) management is very difficult and severely affects the patient's quality of life. Earlier studies have shown that the trigeminal ganglion (TG) comprises several receptors and signal molecules that are involved in the process of peripheral sensitization, which influences the development and persistence of neuropathic pain. Targeting TG can modulate this sensitization pathway and mediate the pain-relieving effect. So far,there are few studies in which modulation approaches to TG itself have been suggested so far. "Trigeminal ganglion modulation" and "trigeminal neuralgia" were used as search phrases in the Scopus Index and PubMed databases to discover articles that were pertinent to the topic. In this review, we address the role of the trigeminal ganglion in TN and underlying molecules and neuropeptides implicated in trigeminal pain pathways in processing pathological orofacial pain. We also reviewed different modulation approaches in TG for TN management. Furthermore, we discuss the prospect of targeting trigeminal ganglion to manage such intractable pain.
Topics: Humans; Trigeminal Ganglion; Quality of Life; Trigeminal Neuralgia; Neuralgia; Facial Pain
PubMed: 36424545
DOI: 10.1186/s10194-022-01512-x -
BMJ Case Reports Sep 2020
Topics: Adult; Biopsy; Chemoradiotherapy; Endoscopy; Female; Hearing Loss; Humans; Magnetic Resonance Imaging; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Squamous Cell Carcinoma of Head and Neck; Syndrome; Treatment Outcome; Trigeminal Neuralgia
PubMed: 32907871
DOI: 10.1136/bcr-2020-237392