Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

Elias, W. Jeffrey; Burchiel, Kim J.

doi:10.1007/s11916-002-0007-8

Cited by 49 publications

(29 citation statements)

References 85 publications

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“…The description of the pain can be identical to that seen in primary TN, with the exception that it tends to be accompanied by a continuous dull pain in the background and by trigeminal hypoesthesia or depression of the corneal reflex [2]. The age of onset may be somewhat younger than in the idiopathic cases, but it depends on the type of the structural lesion.…”

Section: Dear Sirsmentioning

confidence: 75%

Hematoma of Meckel’s cave: a rare possible symptomatic trigeminal neuralgia

et al. 2012

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Dear Sirs,According to the International Classification of Headache Disorders (2004), trigeminal neuralgia (TN) can be divided into classical and symptomatic [1]. The symptomatic TNs represent about 2% of cases and typically are caused by extrinsic lesions that produce neuropathy, demyelination, and axonopathy. We report on an unusual case of symptomatic TN due to an expansile lesion in the Meckel's cave. A 54-year-old man presented with repetitive, severe stabbing pain localized to the left first and second trigeminal branch territory (zygomatic arch and orbit) lasting 1-2 min with a frequency of about 10-15 attacks/day. Despite that this symptomatology had developed abruptly, a dull background of persistent pain in the same region had started about 15 days before. The background pain was associated with photo-phonophobia and worsened with physical exertion. His past medical history was unremarkable. The patient did not present any cerebrovascular risk factors such as smoking, diabetes, or high blood pressure. The neurologic examination revealed an absence of the left corneal reflex and numbness in the ophthalmic and maxillary divisions of the nerve. A contrast-enhanced brain MRI detected an expansile lesion of the Meckel's cave ( Fig. 1a-d) with a cisternal portion and consequent dumbbell appearance. The lesion was T1-hyperintense on non-enhanced images and did not disappear on fat-saturated diffusion-weighted imaging, thus suggesting the presence of blood degradation products; after contrast medium administration, a marked enhancement of the cisternal portion of the trigeminal nerve was noted. Routine blood tests and hemocoagulative screening were normal; conventional catheter angiography of cerebroafferent vessels was negative. The patient underwent surgery that found a swollen and hemorrhagic Gasserian ganglion. At histology, blood without other pathologic tissue or microarteriovenous malformation was evidenced. After surgery, the pain resolved almost completely, while a complete left trigeminal deficit still persisted. At 3-year contrast-enhanced brain MRI, no sign of tumor was found in the Meckel's cave, whereas a severe left masticatory muscles fatty degeneration was noted ( Fig. 1d-f). Indeed, the patient presented with evident facial asymmetry due to severe left temporal and masseter muscle atrophy, without severe functional impairment.Traditionally, secondary TN constitutes a clinical syndrome attributed to a distinct, structural, pathologic lesion such as tumor, aneurysm, or other vascular malformation. The description of the pain can be identical to that seen in primary TN, with the exception that it tends to be accompanied by a continuous dull pain in the background and by trigeminal hypoesthesia or depression of the corneal reflex [2]. The age of onset may be somewhat younger than in the idiopathic cases, but it depends on the type of the structural lesion. We highlight an unusual cause of symptomatic TN related to an unknown-origin bleeding of the Gasserian ganglion mimicking a lesion. In the lite...

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Section: Dear Sirsmentioning

confidence: 75%

Hematoma of Meckel’s cave: a rare possible symptomatic trigeminal neuralgia

et al. 2012

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“…Tricyclic antidepressants, gabapentin, intrathecally local anaesthetics and corticosteroids are the medical treatments used. In the surgical approach, peripheral neurectomy, percutaneous gangliolysis, motor cortex stimulation, stereotactic trigeminal nucleotomy, stimulation of the Gasserian ganglion and trigeminal rootlets are used for trigeminal neuropathic pain (3,12,13,16,18,20,21,26,27). However, we performed CT-guided trigeminal tractotomy for the treatment of this special case.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal neuropathic pain following honeybee sting: a case report

Kahiloğulları

Ugur²,

Tatlı³

et al. 2009

Turkish Neurosurgery

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The neurological complications of bee venom poisoning vary from optic neuritis to pontine hematoma. However, to our best knowledge, trigeminal neuropathic pain secondary to bee sting has not been reported previously in the literature. We report the case of a 52-year-old male patient with right-sided trigeminal neuropathic pain that began a month earlier, following a honeybee sting to the right forehead. The patient was successfully treated by CT-guided percutaneous trigeminal tractotomy. The present report demonstrated that a honeybee sting may result in trigeminal neuropathic pain and CT-guided percutaneous trigeminal tractotomy is effective in the treatment of such cases.

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“…Also how to manipulate such a problem becomes more contentious in cases with bilateral complaints. A multidisciplinary evaluation is essential for this population (11). Even controversial, recommended analgesics and other pain modulators may fail to achieve pain relief.…”

Section: █ Discussionmentioning

confidence: 99%

Staged bilateral nucleus caudalis drez lesioning for persistent idiopathic facial pain: exceptional case report

Kanpolat¹,

Al‐Beyati²,

Yakupoglu³

2014

Turkish Neurosurgery

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We report herein an individual with bilateral PIFP, rare in its nature, in which the patient suffered from intractable pain on her right side after being followed for more than nine years with a similar pain on the left side. She had been treated previously for the left-sided pain with nucleus caudalis DREZ lesioning, resulting in complete relief. For the newly formed right-sided pain, no satisfactory outcome could be achieved with all procedures and medications provided, and she was finally treated with nucleus caudalis DREZ lesioning, with immediate and complete pain relief.

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Trigeminal neuralgia and other neuropathic pain syndromes of the head and face

Cited by 49 publications

References 85 publications

Hematoma of Meckel’s cave: a rare possible symptomatic trigeminal neuralgia

Hematoma of Meckel’s cave: a rare possible symptomatic trigeminal neuralgia

Trigeminal neuropathic pain following honeybee sting: a case report

Staged bilateral nucleus caudalis drez lesioning for persistent idiopathic facial pain: exceptional case report

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