深刺下关穴配合烧山火治疗风寒型三叉神经痛临床研究

目的:观察深刺下关穴配合烧山火治疗风寒型三叉神经痛的临床疗效与机理探讨.方法:选择本院2019年12月-2020年12月收治的风寒型三叉神经痛患者40例随机分为治疗组和对照组,各20例,对照组采用普通针刺,治疗组采用深刺下关穴配合烧山火,比较两组患者临床疗效以及治疗前后简化麦吉尔疼痛问卷评分McGill(VAS评分、疼...     

Cranial nerve involvement in Charcot–Marie–Tooth Disease

BackgroundCharcot–Marie–Tooth Disease (CMT) is a rare disorder with less than 200,000 cases reported in the US every year, making diagnosis challenging. MR and CT imaging has become more common in the evaluation of CMT to identify areas of disease involvement.Case reportA 27-year-old female from Guatemala with a past history of polio initially presented to the emergency room for necrotizing pneumonia.MRI images demonstrated smoothly enlarged, mildly enhancing trigeminal nerves. CT showed bony widening of the skull base foramina. The patient was noted to have atrophy and weakness of her extremities with decreased sensation, distal more than proximal, and pes cavus. An electromyogram demonstrated absent response in the right median, ulnar, peroneal, and tibial motor studies and bilateral radial and right sural sensory studies. MRI of the spine demonstrated smooth, symmetric enlargement and mild enhancement of the distal spinal nerve roots and cauda equine.DiscussionCMT is a group of disorders with a wide range of clinical presentations and abnormalities. Cranial nerve involvement is infrequently described in CMT 1A. In our case and prior studies, there does not appear to be a correlation between cranial nerve involvement and symptoms. Trigeminal neuralgia has been described in patients in CMT, but is not common and was not seen in our patient despite abnormal trigeminal nerve findings on imaging. Our patient also demonstrated involvement of the facial nerve without facial muscle weakness. Clinical features are key in distinguishing CMT 1A from other forms of HMSN.     

Etiologic exploration of magnetic resonance tomographic angiography negative trigeminal neuralgia

Our objective was to explore the etiologic factors involved in trigeminal neuralgia with negative magnetic resonance tomographic angiography (MRTA) results. Clinical data from 341 patients with idiopathic trigeminal neuralgia who were treated with neurovascular decompression between March 2003 and December 2011 were retrospectively analyzed. The etiologic causes of preoperative MRTA-negative trigeminal neuralgia were categorized based on comparisons between preoperative MRTA and intraoperative endoscopic images. MRTA was highly sensitive (92.4%, 291/315) to neurovascular compression, whereas its specificity was 65.4% (17/26). Among the 24 false-negative cases, there were nine patients with petrosal vein compression, 12 with superior cerebellar artery compression, two with superior cerebellar arterial branch compression, and one patient with anterior inferior cerebellar artery compression. Among the 17 true-negative cases, three patients had arachnoid adhesions, one had a protruding temporal eminence, five had micro-cholesteatomas, and eight patients exhibited no compression. The factors responsible for the MRTA-negative results included small-diameter arterial vessels, veins with slow blood flow, arachnoid adhesions, protruding temporal eminences, micro-cholesteatomas, and other pathologies such as multiple sclerosis. Preoperative diagnoses of MRTA-negative patients need to integrate the MRI results from multiple sequences to discriminate between arteriolar compression, venous compression, and small compressive lesions. When narrow cerebellopontine angles are shown in MRTA, arachnoid adhesion and temporal eminence compression should be considered.     

Symptoms from masked acrolein exposure suggest altered trigeminal reactivity in chemical intolerance

BackgroundChemical intolerance (CI) is a widespread occupational and public health problem characterized by symptoms that reportedly result from low-levels of chemical exposure. The mechanisms behind CI are unknown, however modifications of the chemical senses (rather than toxic processes) have been suggested as key components. The aim of this study was to investigate whether individuals with self-reported CI report more sensory irritation during masked acrolein exposure compared to controls without CI.MethodsIndividuals with CI (n = 18) and controls without CI (n = 19) were exposed in an exposure chamber. Each participant took part in two exposure conditions – one with heptane (the masking compound), and one with heptane and acrolein at a dose below previously reported sensory irritation thresholds. The exposures lasted for 60 min. Symptoms and confidence ratings were measured continuously throughout the exposure as were measurements of electrodermal activity and self-reported tear-film break-up time. Participants were blind to exposure condition.ResultsIndividuals with CI, compared with controls reported greater sensory irritation in the eyes, nose and throat when exposed to acrolein masked with heptane. There was no difference during exposure to heptane.ConclusionsMasked exposure to acrolein at a concentration below the previously reported detection threshold is perceived as more irritating by individuals with CI compared with controls. The results indicate that there is altered trigeminal reactivity in those with CI compared to controls.     

Anatomical Observations During Microvascular Decompression for Idiopathic Trigeminal Neuralgia (with Correlations Between Topography of Pain and Site of the Neurovascular Conflict). Prospective Study in a Series of 579 Patients

Summary  Background. The Micro-Vascular Decompression (MVD) procedure – developed for conservative treatment of idiopathic Trigeminal Neuralgia (TN) is based on the NeuroVascular Conflict (NVC) theory. Although MVD has become very popular over the last twenty years, its principles and value remain controversial. Detailed anatomical observations during posterior fossa exploration in patients with idiopathic TN may help to understand better the role of NVCs.  Method. In this article, the authors report the anatomical observations made under the operating microscope in a consecutive series of 579 patients suffering from idiopathic TN who were treated by MVD.  Findings. In 19 cases (3.3%) no neuro-vascular conflict was found. In the remaining 560 (96.7%) one or several offending vessel(s) were identified. A superior cerebellar artery alone or in association with other “conflicting” vessel(s) was found in 88% of the patients, an anterior-inferior cerebellar artery (alone or in association) in 25.1%, a vein embedded in the nerve (alone or in association) in 27.6%, the basilar artery (alone or in association) in 3.5%. Of prime importance, several “conflicting” vessels were found in association in 37.8% of the patients. Location of the NVC was in the trigeminal root entry zone in 52.3% of the patients, in the midthird of the nerve in 54.3% and at the exit of the nerve from Meckel cave in 9.8%. The relation of the predominant conflict with the surface of the nerve was supero-medial in 53.9%, supero-lateral in 31.6% and inferior in 14.5%. The degree of severity of the main conflict was a simple contact with the nerve in 17.6%, a distorsion of the nerve in 49.2% and a marked indentation in 33.2%.  Alteration of the whole trigeminal nerve was frequently observed. In 42% of patients, the nerve had a significant degree of global atrophy. In 18.2%, there was a local thickening of arachnoid membranes, adherent to the nerve. In 12.6%, the root had a marked angulation on crossing over the petrous ridge. Finally in 3.9%, the nerve was compressed between pons and petrous bone, due to the small size of the posterior fossa.  Interpretation. It is concluded that NVC in this series played an important role as a causative factor of the neuralgia, as classical; but other – possibly responsible – anatomical factors were found, especially a global atrophy of the root, a focal arachnoid thickening, a ribbon-shaped and angulated root on crossing over the petrous ridge . . .     

Trigeminal neuraligia. A retrospective survey of a sample of patients in singapore and Malaysia

This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in them present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in general population.     

A comparative physiological and morphological study of periodontal ligament mechanoreceptors represented in the trigeminal ganglion and the mesencephalic nucleus of the cat

A correlative morphological study was carried out on two electrophysiologically identified and located periodontal ligament mechanoreceptors in anaesthetised cats. One mechanoreceptor had its cell body in the mesencephalic nucleus and the other had its cell body in the trigeminal ganglion. Physiological recordings were made from each of their cell bodies. The two receptors were located by punctate and electrical stimuli in the labial aspect of the periodontal ligament of the left mandibular canine tooth. Both receptors had similar positions relative to the tooth apex and fulcrum and were situated in the labial part of the ligament in each tooth. The receptor loci were marked, and these regions were studied in a series of semi-thin and ultra-thin sections. Only Ruffini nerve endings were observed under each ink mark. Both Ruffini nerve endings branched, were unencapsulated and were incompletely surrounded by terminal Schwann cells with extensions projecting towards collagen bundles. The results indicate that periodontal ligament mechanoreceptors with cell bodies in the mesencephalic nucleus and those with their cell bodies in the trigeminal ganglion can both be Ruffini nerve endings. Furthermore, there was no apparent morphological difference between the two periodontal ligament mechanoreceptors.     

三叉神经支配对面瘫后肌球蛋白重链亚型的影响

目的：探讨三叉神经对失神经支配后面部上唇提肌肌球蛋白重链(MHC)各亚型变化的影响。方法：采用组织化学、SDS-PAGE凝胶电泳以及电生理等方法观察上唇提肌形态学、电刺激收缩阈值、最大收缩力以及MHC各亚型的变化。结果：三叉神经可以明显减轻面肌MHC各亚型去神经后的蛋白降解，维持肌纤维的兴奋阈值，保持肌纤维的最大收缩力。结论：肌肉失神经支配后，感觉神经可以减轻MHC各亚型的蛋白降解，临床修复运动神经时应尽可能同时修复感觉神经。