About Neuralgia, its Symptoms & Treatment

Definition

Craniofacial neuralgias are characterized by sudden paroxysmal pain along the distribution of one or ore of the cranial or upper cervical spinal curves.

Neuralgias of the Craniofacial region include Trigeminal neuralgia geniculate neuralgia, glossopharyngeal neuralgia occipital neuralgia, herpes zoster, and postherpetic neuralgia .

Trigeminal neuralgia may be primary or secondary. Idiopathic Trigeminal neuralgia or tic douloureux has been recognized for centuries as an extremely painful disorder most commonly involving.

The maxillary nerve. Recurrent lancinating, shocklike unilateral pain lasting seconds to minutes is provoked by non noxious stimulation of the skin at specific sites around the face and less frequently by movement of the tongue.

These trigger zones are usually with in same dermatome as the painful sensation. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce the pain idiopathic.

Trigeminal neuralgia occurs some what more frequently in women and usually begins in individuals 50 to 70 years of ages.There is no pain between attacks, and the frequency of painful episodes can range from several per day to only a few per year.

With time, the features may become more atypical, with greater areas of more enduring and dull pain and occasionally bilateral pain, though rarely on both sides simultaneously.

NO sensory or reflex deficit is detectable by routine neurologic testing. Diagnostic local anesthetic blocks will identify the specific nerves in volved and the trigger point distribution.

Neurologic and neuroradiologic examination is advised in all cases to rule our disease such as intracranical tumors, vascular malformations or multiple sclerosis.

No unified theory exists to explain the etiology or Trigeminal neuralgia , and in reality the disorder probably has multiple etiologies. Vascular compression of the Trigeminal ganglion by near by arteries has been observed in some patients, and microvasular decompression can elimate the pain in selected individuals .

Progressive degeneration and demyelination of the Trigeminal ganglion and dorsal root also have been implicated . Demyelination decreases the ratio of myelinated to unmyelinated nerve fibers and may there by alter central sensory processing due to change in spinal and brain stem gating mechanisms.

It also permits ephaptic transmission between peripheral efferents or low threshold mechanoreceptors and nociceptive afferents, leading to spontaneous painful sensations and painful sensations following nonnoxious stimulation.


Finally , evidence that spontaneous afferent impulses occur in the dorsal root ganglion and in the periphery suggests the possibility for central , temporal and spatial summation of background activity to painful proportions. Secondary Trigeminal neuralgia , peripheral nerve injury or CNS lesions involving the Trigeminal pathways.

Every patient with Trigeminal neuralgia like symptoms should under go neurologic and neuroradiologic evaluation to rule out the possibility of intracranical or extra cranial tumors.

Vascular malformations, or degenerative changes as in multiple sclerosis. Patients with Trigeminal neuralgia secondary to multiple sclerosis are more likely to have bilateral facial pain than those with idiopathic Trigeminal neuralgia

Trigeminal neuralgia (TIC Douloureux): Clinical Manifestation

Trigeminal neuralgia is characterized by excruciating paroxysms of pain in the lips, gums, check, or chin and very rarely, in the distribution of the ophthalmic division of the 5th nerve .

The pain seldom lasts more that a few seconds or a minutes or two but may be so intense that the patients winces, hence the term tic. The paroxysms, experienced as single jabs or clusters, tend to recur frequently, both day and night for several weeks at a time.

They may occur spontaneously or with movements of affected areas evoked by speaking ,chewing, or smiling . Another characteristics feature is the presence of trigger zones, typically on the face, lips or tongues.

That provoken attacks: patients may report that tactile stimuli e.g. washing the face, brushing the teeth, or exposure to a draft of air generate excruciating pain, An essential feature be demonstrated on examination.

Trigeminal neuralgia is relatively common, with an estimated annual incidence of 4.5 per 100.000 individuals. Middle aged and elderly persons are affected primarily and 60% of cases occur in women.

Onset is typically sudden and bouts tend to persist for week or months before remitting spontaneously. Remissions may be long lasting but in most patients the disorder ultimately recurs.

Also check out the following article on Treatment process for trigeminal neuralgia

 

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