SUNCT and trigeminal neuralgia attributed to meningoencephalitis

We describe a 46-year-old female with viral meningoencephalitis (likely varicella-zoster virus) who developed a SUNCT syndrome followed a few days later by trigeminal neuralgia. Both disorders resolved in parallel with the resolution of encephalitis, which suggests a causal link. In conclusion, headache attributed to intracranial infection may have the clinical features of SUNCT or TN.     

"SUNCT" syndrome. A case of transformation from trigeminal neuralgia?

A patient with typical trigeminal neuralgia involving the first branch of the nerve developed short-lasting unilateral attacks in the same area which were associated with severe vasomotor phenomena consistent with the recently described SUNCT syndrome. This evolution suggests that SUNCT might correspond, at least in this case, to a "transformed" trigeminal neuralgia and emphasizes the close relationship between these unilateral facial pain syndromes.     

SUNCT syndrome or first division trigeminal neuralgia associated with cerebellar hypoplasia

Short-lasting unilateral neuralgiform headache (SUNCT) and first division trigeminal neuralgia (TN) are rare and very similar periorbital unilateral pain syndromes. Few cases of SUNCT are associated with posterior skull lesions. We describe a 54-year-old man with symptoms compatible with both the previous painful syndromes, associated with a small posterior skull and a cerebellar hypoplasia. The short height and the reported bone fractures could be compatible with a mild form of osteogenesis imperfecta, previously described in one case associated with SUNCT. However, a hypoplastic posterior cranial fossa characterizes also Chiari I malformation. The difficult differential diagnosis between SUNCT and TN and their relation with posterior skull malformations is debated.     

Spinal baclofen in trigeminal neuralgia. A case report

Oral baclofen, the most often prescribed antispastic drug, has been shown to be effective in trigeminal neuralgia. Spinal application of baclofen leads to a complete supression of spasticity even in cases in which no previous oral antispastic medication achieved a response. Since these results suggest that spinal administration of baclofen is superior to oral baclofen, spinal injections of this drug (100 mug) were tested in a patient with severe trigeminal neuralgia that was unresponsive to oral medication. This was followed by complete suppression of the neuralgic symptoms, which however reoccurred if baclofen administration was stopped. Spinal baclofen has also been effective during long-term infusion with an implanted pump for more than 1 year. Spinal baclofen infusion seems to be a possibility in the treatment of severe trigeminal neuralgia resistant to other forms of therapy.     

Pharmacotherapy of trigeminal neuralgia.

The efficacy of the anticonvulsant drug carbamazepine in the management of trigeminal neuralgia is evidenced in several controlled trials, and the numbers needed to treat to obtain one patient with at least 50% pain relief (NNT) is 1.7. Single small trials have shown that baclofen alone provides pain relief (NNT = 1.4) and that lamotrigine has an additional effect in patients with insufficient relief using carbamazepine or phenytoin (NNT = 2.1). Uncontrolled observations and clinical practice indicate that phenytoin, clonazepam, sodium valproate, gabapentin, and lidocaine will also relieve trigeminal neuralgia. In case of lacking effect of a single drug, combination of two or more drugs may be used, but with the exception of the lamotrigine-carbamazepine combination, this is not evidence-based medicine. Acute exacerbation has successfully been treated with intravenous loading with phenytoin or lidocaine, but again these procedures have not been tested in controlled trials. In conclusion, carbamazepine is the mainstay of pharmacotherapy of trigeminal neuralgia, and secondary drug choices are baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, and sodium valproate. Controlled trials testing the effect of some of these drugs, new drugs, and drug combinations are needed.     

Case of microarteriovenous malformation-induced trigeminal neuralgia treated with radiosurgery

Radiosurgery to the right fifth cranial nerve was performed with the Gamma Knife on a 39- year-old patient who presented with classic symptoms of trigeminal neuralgia (TN), but was found on imaging studies to harbour a small intrinsic vascular malformation within the nerve. Based on size and drainage, the arteriovenous malformation (AVM) was Spetzler-Martin Grade III and no previous history of bleeding was reported. The patient had failed a trial of carbamazepine, and no surgical procedures had been performed. A decrease in symptoms was reported by the 6-month follow- up. A review of the literature on microAVM-induced TN is provided as well as a discussion of management.     

3.0T磁共振成像在血管压迫性三叉神经痛中的应用

目的 探讨3.0T MRI在血管压迫性三叉神经痛中的应用。方法 对32例三叉神经痛患者行轴位3D-TOF MRA及3D-FIESTA-C,并分别进行MPR、CMPR及仿真内镜重建（MRVE）,分析患侧血管与神经的关系。结果 32例中,5例（5/32,15.63%）患侧血管与神经无接触,4例（4/32,12.50%）可疑接触,5例（5/32,15.63%）明确接触;18例（18/32,56.25%）存在压迫,其中14例（14/18,77.78%）责任血管为小脑上动脉,2例（2/18,11.11%）为岩静脉,另外分别为小脑前下动脉、基底动脉各1例（1/18,5.56%）。对其中15例行微血管减压术（MVD）,MRI所示责任血管与术中所见相吻合;术后11例疼痛消失,4例疼痛较前明显减轻。结论 3.0T MRI可有效区分导致血管压迫性三叉神经痛的责任动脉及静脉与神经的关系;3D-FIESTA-C的CMPR及MRVE可提高判断接触与压迫的敏感度与准确率,对显示责任静脉具有优势,MRVE三维空间立体定位可作为MVD术前评估的有力补充。     

原发性三叉神经痛患者行显微血管减压术的护理

目的总结原发性三叉神经痛患者行显微血管减压治疗的护理要点。方法对62例原发性三叉神经痛患者实施显微血管减压治疗,并做好术前后的护理工作。结果术后治愈52例,好转10例,术后2例发生伤口脑脊液漏,2例发生口唇疱疹,经对症处理后痊愈。结论显微血管减压治疗原发性三叉神经痛,具有较高的治愈率、止痛效果明显、损伤少等优点。术前应做好患者心理护理及疼痛护理,术后密切观察患者病情变化,做好并发症的观察及健康指导,其能减轻患者的痛苦,对患者的康复具有重要意义。     

三维双回波磁共振动静脉成像技术诊断血管压迫性三叉神经痛

目的 探讨三维双回波磁共振动静脉成像（3D双回波MRAV）对血管压迫性三叉神经痛的诊断价值。方法 选取30例拟行三叉神经微血管减压术患者,术前行三维时间飞跃（3D TOF）序列和3D双回波MRAV序列成像,以手术结果为金标准,分析两种成像方法的图像质量和诊断动、静脉压迫三叉神经的一致性和效能。结果 3D双回波MRAV成像的SNR和CNR低于3D TOF法（t=4.50、7.43,P均<0.001）。3D双回波MRAV诊断压迫三叉神经的动脉、静脉责任血管的敏感度为97.22%（35/36）,特异度为83.33%（20/24）,准确率91.67%（55/60）,与手术结果一致性较高（Kappa=0.82）;3D TOF诊断动脉、静脉压迫三叉神经的敏感度、特异度分别为69.44%（25/36）、95.83%（23/24）,准确率为80.00%（48/60）,一致性低于3D双回波MRAV（Kappa=0.61）。结论 3D双回波MRAV序列可显示三叉神经根部与动、静脉位置关系,对血管压迫性三叉神经痛具有较高的诊断价值。     

Diagnosis and differential diagnosis of trigeminal neuralgia.

Trigeminal neuralgia is a chronic facial pain classified as a neuropathic pain. There is widespread agreement regarding the International Association for the Study of Pain definition of classical idiopathic trigeminal neuralgia as "a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve." However, there are variations in presentation that are less easy to diagnose and an erroneous diagnosis of trigeminal neuralgia is occasionally made. In patients with tumors or multiple sclerosis, trigeminal neuralgia is termed secondary. Currently, clinical manifestations are the mainstay for diagnosis because there are no objective tests to validate the diagnosis. The sensitivity and specificity of these clinical manifestations is reviewed. Magnetic resonance imaging (MRI) and three-dimensional fast-in-flow with steady-state precession MRI are performed to determine the presence of tumors or plaques of multiple sclerosis and to assess possible compressions and deformations of the trigeminal nerve. Their specificity and sensitivity regarding compressions found at the time of surgery is reviewed. Other differential diagnoses for chronic unilateral orofacial pain are discussed.     

Petrous angle and trigeminal neuralgia

The angle of the petrous portion of the temporal bone was measured at the site where it is crossed by the trigeminal nerve. Measurement was facilitated by using the impression techniques of dentistry to produce a plaster model of the bone, and the model was then sawn across to show the angle clearly. Considerable variation was found. Certain bone irregularities were observed and these could also conceivably be factors in the causation of trigeminal neuralgia. An attempt to reveal the angle of the petrous bone by radiology was successful in some cases but not in others. Further investigation along these lines might be of value in patients suffering from idiopathic trigeminal neuralgia.     

Nerve coblation for treatment of trigeminal neuralgia: A case report

BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation(NC).CASE SUMMARY A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography(CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular,and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness(level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.CONCLUSION CT-guided gasserian ganglion(NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.     

Classic trigeminal neuralgia: a surgical perspective.

Classic trigeminal neuralgia (TN) was described as early as the first century AD, when treatments ranged from bloodletting to the application of poison-laden bandages. Current medical treatment utilizes a variety of drug therapies. Surgery is reserved for those who are unable to tolerate the side effects or in situations in which the drugs prove to be ineffective. Surgical options include microvascular decompression, percutaneous balloon compression, radio-frequency thermocoagulation, and glycerol injection. Nurses play a critical role in the multidisciplinary care of patients undergoing surgical procedures for TN.     

Subclinical sensory abnormalities in trigeminal neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.