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Trigeminal neuralgia etiology

Danielle D DeSouza, Mojgan Hodaie, Karen D Davis
Classical trigeminal neuralgia (TN) is a chronic pain disorder that has been described as one of the most severe pains one can suffer. The most prevalent theory of TN etiology is that the trigeminal nerve is compressed at the root entry zone (REZ) by blood vessels. However, there is significant evidence showing a lack of neurovascular compression (NVC) for many cases of classical TN. Furthermore, a considerable number of patients who are asymptomatic have MR evidence of NVC. Since there is no validated animal model that reproduces the clinical features of TN, our understanding of TN pathology mainly comes from biopsy studies that have limitations...
2016: Frontiers in Neuroanatomy
K Rammohan, Shyma M Mundayadan, Robert Mathew
CONTEXT: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2-6 cm in diameter. AIMS: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. SETTINGS AND DESIGN: A prospective, observational study conducted in a tertiary care center...
October 2016: Journal of Neurosciences in Rural Practice
Yongxu Wei, Weiguo Zhao, Chunhua Pu, Ning Li, Yu Cai, Hanbing Shang, Wenlei Yang
OBJECTIVE: The purpose of this study was to compare clinical features, long-term surgical outcomes between patients with idiopathic and tumor-related trigeminal neuralgia (TN), and to identify factors associated with the maintenance of permanent pain-free state. METHODS: Between January 2003 and December 2013, 360 patients with idiopathic TN and 39 patients with tumor-related TN who had undergone microsurgery were retrospectively studied. Kaplan-Meier survival curves were generated and compared by Log-rank test, and the possible prognostic factors were analyzed by the Cox proportional-hazards regression...
September 20, 2016: British Journal of Neurosurgery
Pengfei Liu, Wenxiang Zhong, Chenlong Liao, Ming Liu, Wenchuan Zhang
Primary trigeminal neuralgia (TN) may occasionally occur in absence of neurovascular compression. A mechanism other than nerovascular compression may play a role in TN. High-resolution computed tomographies (CTs) of 21 consecutive TN patients without vascular compression during surgery and 30 healthy volunteers were retrospectively performed. Measuring parameters (length, width, and aspect ratio) were obtained in the axial plane for foramen ovale, and in the reconstructed coronal plane for foramen rotundum on both sides in each subject...
August 25, 2016: Journal of Craniofacial Surgery
Akshitkumar M Mistry, Kurt J Niesner, Wendell B Lake, Jonathan A Forbes, Chevis N Shannon, Rebecca A Kasl, Peter E Konrad, Joseph S Neimat
BACKGROUND: Trigeminal neurovascular contact (NVC) is hypothesized to be the etiology of classical trigeminal neuralgia (TGN). We aimed to seek a correlation between types of NVCs and the presence of TGN as well as early surgical outcome in TGN patients treated with trigeminal microvascular decompression (MVD). METHODS: We blindly analyzed preoperative high-resolution MRIs with respect to the degree ('none', 'touch', or 'compression') and location of bilateral NVC in 57 retrospectively identified Burchiel Type 1 TGN patients treated by MVD...
August 18, 2016: World Neurosurgery
Amparo M Wolf, Ingrid Aguiar-Littig, Girish Fatterpekar, Douglas Kondziolka
INTRODUCTION: With improving MRI techniques, physicians can better visualize neurovascular compression (NVC) of the trigeminal nerve, as well as proximal and distal nerve atrophy, nerve distortion, and demyelinating plaques. This study aimed to determine the interrater reliability of these different anatomical variables, as well as the accuracy in predicting the side of trigeminal neuralgia (TN) for 2 neuroradiologists. METHODS: High-resolution MRI sequences including T1-Gadolinium and constructive interference in steady state (CISS) sequences were reviewed in 43 patients, with symptomatic TN in 44 nerves, who subsequently underwent Gamma Knife radiosurgery...
August 2016: Neurosurgery
C Rory Goodwin, Debebe Theodros, Nancy A Abu-Bonsrah, Matt Bender, Xin Zhou, Rafael De la Garza-Ramos, Dimitrios Mathios, Tomas Garzon-Muvdi, Ari M Blitz, Alessandro Olivi, Benjamin S Carson, Chetan Bettegowda
INTRODUCTION: Trigeminal neuralgia (TN) is a pain disorder characterized by paroxysmal lancinating pain along the distribution of the trigeminal nerve. Mounting clinical evidence supports the neurovascular compression (NVC) theory, suggesting vascular compression results in the manifestation of debilitating pain. Microvascular decompression (MVD) is the only known surgical intervention that directly addresses this proposed etiology. METHODS: A retrospective review of patient records at the Johns Hopkins Hospital from 1998 to 2015 revealed 942 patients with TN and 500 patients who underwent MVD...
August 2016: Neurosurgery
Daniel P Seeburg, Benjamin Northcutt, Nafi Aygun, Ari M Blitz
High-resolution MRI affords exquisite anatomic detail and allows radiologists to scrutinize the entire course of the trigeminal nerve (cranial nerve [CN] V). This article focuses first on the normal MRI appearance of the course of CN V and how best to image each segment. Special attention is then devoted to the role of MRI in presurgical evaluation of patients with neurovascular conflict and in identifying secondary causes of trigeminal neuralgia, including multiple sclerosis. Fundamental concepts in postsurgical imaging after neurovascular decompression are also addressed...
July 2016: Neurosurgery Clinics of North America
Ratinder Jhaj, Pushp Raj Gour, Dinesh Prasad Asati
Black hairy tongue (BHT) is a benign disease characterized by elongated filiform lingual papillae, with a carpet-like appearance of the dorsum of the tongue. It is has been reported to occur with a prevalence ranging from 0.6% to 11.3%. Although its etiology is not fully understood, BHT may be triggered by smoking, excessive coffee or black tea drinking, poor oral hygiene, trigeminal neuralgia, general debilitation, dry mouth as well as certain drugs. We present here a case of a patient with psychosis, depression, and benign prostatic hyperplasia, who developed BHT following treatment with a fixed dose combination (FDC) of olanzapine and fluoxetine and recovered within 3 months after withdrawal of treatment with FDC...
May 2016: Indian Journal of Pharmacology
Bryan K Ward, Daniel R Gold
Vestibular paroxysmia is the name given to vascular compression of the vestibulocochlear nerve. Substantial evidence has been discovered in support of vascular compression of the trigeminal nerve as the etiology for trigeminal neuralgia, and effective therapies have been targeted to address this pathophysiology. Perhaps due to the common and often vaguely-described symptoms of dizziness and tinnitus, vascular compression of the vestibulocochlear nerve as a cause of symptoms has remained controversial. Recent clinical studies, however, have better defined diagnostic criteria for vestibular paroxysmia...
2016: Open Journal of Clinical & Medical Case Reports
K Hufschmidt, J Fernandez, T Balaguer, D Fontaine, B Chignon-Sicard
INTRODUCTION: Trigeminal trophic syndrome (TTS) can occur after any injury on the fifth cranial nerve. The etiology is dominated by iatrogenic causes, especially after gasserian ganglion ablation. Middle-aged women are mostly involved and the differential diagnosis is vast. PRESENTATION OF CASE: A 88-year old woman presented with TTS and destruction of the right nasal ala 25 years after retrogasserian alcohol injection for trigeminal neuralgia. Facing iterative failure of medical treatment, topics and neurostimulation, we performed lipofilling for the lesion...
April 20, 2016: Annales de Chirurgie Plastique et Esthétique
Andy R Eugene
Trigeminal Neuralgia is a disorder that is characterized with electrical-type shocking pain in the face and jaw. This pain may either present as sharp unbearable pain unilateral or bilaterally. There is no definite etiology for this condition. There are various treatment methods that are currently being used to relieve the pain. One of the pharmacological treatments is Carbamazepine and the most prevalent surgical treatments include Gamma Knife Surgery (GKS), Microvascular Decompression (MVD) and Radiofrequency Lesioning (RFL)...
September 2015: Brain: Broad Research in Artificial Intelligence and Neuroscience
G-Q Zhang, Y Meng
Multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Symptoms of orofacial pain, trigeminal neuralgia, spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease...
December 2015: European Review for Medical and Pharmacological Sciences
Hyun Seung Jin, Ji Yeon Shin, Yong-Chul Kim, Sang Chul Lee, Eun Joo Choi, Pyung-Bok Lee, Jee Youn Moon
BACKGROUND: Radiofrequency thermocoagulation (RFT) has been widely used to manage trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for managing TN with RFT can decrease morbidity and improve treatment efficacy. OBJECTIVES: The goal of this study was to determine clinical variables related to the treatment outcome in patients with TN undergoing RFT. STUDY DESIGN: Retrospective analysis. SETTING: University hospital in Korea...
November 2015: Pain Physician
Concetta Alafaci, Giovanni Grasso, Francesca Granata, Daniele Marino, Francesco M Salpietro, Francesco Tomasello
BACKGROUND: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel's cave (MC) causing symptomatic TN is very rare. CASE DESCRIPTION: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive neurological improvement...
2015: Surgical Neurology International
Patrick W Hitchon, Mario Zanaty, Toshio Moritani, Ergun Uc, Connie L Pieper, Wenzhuan He, Jennifer Noeller
OBJECTIVE: For patients with medically unresponsive trigeminal neuralgia (TIC) and hemifacial spasm (HS), surgical microvascular decompression (MVD) is the procedure of choice. The authors of this report sought to review their outcomes with MVD in patients with TIC and HS, and the success of preoperative magnetic resonance imaging (MRI) in identifying the offending vascular compression. METHODS: Since 2004, there were a total of 51 patients with TIC and 12 with HS with available MRI scans...
December 2015: Clinical Neurology and Neurosurgery
Rajat Goel, Sanjeev Kumar, Ajay Panwar, Abhishek B Singh
Orofacial pain' most commonly occurs due to dental causes like caries, gingivitis or periodontitis. Other common causes of 'orofacial pain' are sinusitis, temporomandibular joint(TMJ) dysfunction, otitis externa, tension headache and migraine. In some patients, the etiology of 'orofacial pain' remains undetected despite optimal evaluation. A few patients in the practice of clinical dentistry presents with dental pain without any identifiable dental etiology. Such patients are classified under the category of 'atypical odontalgia'...
2015: Open Dentistry Journal
William P Cheshire
PURPOSE OF REVIEW: Pain arising from cranial neuralgias represents a significant health burden. Successful treatment depends on accurate diagnosis, which requires knowledge of neuroanatomy and pathophysiology as well as familiarity with the varied clinical presentations encountered in neurologic practice. This article delineates the relevant anatomy, clinical features, and management of the most common primary and secondary cranial neuralgias. RECENT FINDINGS: Trigeminal neuralgia, which can result from neurovascular compression or demyelination, is a particularly severe form of facial pain...
August 2015: Continuum: Lifelong Learning in Neurology
Michael A Henry, Dara D Fairchild, Mayur J Patil, Taleen Hanania, Heather S Hain, Scott F Davis, Sam A Malekiani, Andrew Hu, Roy Sucholeiki, Darrell Nix, Irving Sucholeiki
AIMS: To study the effects of a novel matrix metalloproteinase-2 (MMP-2) and MMP-9 inhibitor, AQU-118, on mechanical allodynia in the spinal nerve ligation (SNL) model of neuropathic pain and the chronic constriction injury of the infraorbital nerve (CCI-IoN) model of neuropathic orofacial pain. METHODS: Five groups of SNL rats were given daily oral doses of AQU-118 (5, 10, 20 mg/kg), gabapentin (100 mg/kg), or vehicle (0.5% methylcellulose) and then paw withdrawal threshold was measured with von Frey filaments (VF)...
2015: Journal of Oral & Facial Pain and Headache
Johann Klein, Sahr Sandi-Gahun, Gabriele Schackert, Tareq A Juratli
OBJECTIVE: Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our experience with this technique in a small patient cohort. METHODS: Records of 10 patients (five men, five women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were retrospectively analyzed. Patients' data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated...
April 2016: Cephalalgia: An International Journal of Headache
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