Objective Assessment of Autonomic Signs During Triggered First Division Trigeminal Neuralgia

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 ± 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.

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Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia: A prospective clinical study using 3.0 Tesla MRI

Cephalalgia ◽

10.1177/0333102414566819 ◽

2015 ◽

Vol 35 (12) ◽

pp. 1077-1084 ◽

Cited By ~ 20

Author(s):

Stine Maarbjerg ◽

Frauke Wolfram ◽

Aydin Gozalov ◽

Jes Olesen ◽

Lars Bendtsen

Keyword(s):

Trigeminal Neuralgia ◽

Clinical Characteristics ◽

Cross Sectional Study ◽

Prospective Clinical Study ◽

Structured Interviews ◽

3.0 Tesla ◽

Cross Sectional ◽

Classical Trigeminal Neuralgia ◽

Duration Of Disease ◽

Symptomatic Side

Background Previous studies demonstrated that a severe neurovascular contact (NVC) causing displacement or atrophy of the trigeminal nerve is highly associated with classical trigeminal neuralgia (TN). There are no studies describing the association between the clinical characteristics of TN and severe NVC. Methods Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. Results We included 135 TN patients. Severe NVC was more prevalent in men (75%) compared to women (38%) ( p < 0.001), and the odds in favor of severe NVC on the symptomatic side were 5.1 times higher in men compared to women (95% CI 2.3–10.9, p < 0.001). There was no difference between patients with and without severe NVC in age (≥60 years vs. <60) (OR 1.6 95% CI (0.8–3.4), p = 0.199) or duration of disease ( p = 0.101). Conclusions Severe NVC was much more prevalent in men than in women, who may more often have other disease etiologies causing or contributing to TN. Severe NVC was not associated with age or with duration of disease.

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Successful Endovascular Treatment of Trigeminal Neuralgia Caused by a CarotidCavernous Fistula: Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.07.09 ◽

2020 ◽

pp. 1-4

Author(s):

Luciano Manzato ◽

Paulo M. Mesquita Filho ◽

Octavio Karam ◽

Victor E. Angeliero ◽

...

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Endovascular Treatment ◽

World Literature ◽

Cranial Nerves ◽

Conjunctival Injection ◽

Arteriovenous Fistulas ◽

Fourth Report ◽

The World ◽

Dural Arteriovenous Fistulas

Dural arteriovenous fistulas (DAVFs) of the cavernous sinus are arteriovenous connections located in the dura mater leaflets of this region. The usual presentation of a DAVF is predominantly ocular, with symptoms such as diplopia, conjunctival injection, involvement of cranial nerves III/IV/VI, exophthalmos, and chemosis. Trigeminal neuralgia caused by a cavernous DAVF is extremely rare. To the best our knowledge, this is only the fourth report in the world literature. We describe the case of a patient treated by embolization in whom the only presenting symptom of DAVF was trigeminal neuralgia. After endovascular treatment, the patient became asymptomatic.

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Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Cephalalgia ◽

10.1177/0333102420974356 ◽

2020 ◽

pp. 033310242097435

Author(s):

Navid Noory ◽

Emil Andonov Smilkov ◽

Jette Lautrup Frederiksen ◽

Tone Bruvik Heinskou ◽

Anne Sofie Schott Andersen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Trigeminal Neuralgia ◽

Odds Ratio ◽

Morphological Changes ◽

3.0 Tesla ◽

Classical Trigeminal Neuralgia ◽

Mri Scans ◽

Low Prevalence ◽

Headache Center ◽

Symptomatic Side

Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)

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Objective assessment of bilateral conjunctival injection during cluster headache attacks

Neurology ◽

10.1212/01.wnl.0000250269.25925.f5 ◽

2007 ◽

Vol 68 (1) ◽

pp. 75-76 ◽

Cited By ~ 5

Author(s):

M. Baron ◽

P. Gili ◽

M. Sanchez-del-Rio ◽

F. J. Barriga ◽

J. Yanguela ◽

...

Keyword(s):

Cluster Headache ◽

Objective Assessment ◽

Conjunctival Injection

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Medullary infarction causing coexistent SUNCT and trigeminal neuralgia

Cephalalgia ◽

10.1177/0333102416652093 ◽

2016 ◽

Vol 37 (5) ◽

pp. 486-490 ◽

Cited By ~ 8

Author(s):

Giorgio Lambru ◽

Michele Trimboli ◽

S Veronica Tan ◽

Adnan Al-Kaisy

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Trigeminal Autonomic Cephalalgias ◽

Conjunctival Injection ◽

Neurovascular Conflict ◽

First Case ◽

Clinical Variants ◽

Broad Variety ◽

Medullary Infarction

Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or with autonomic symptoms (SUNA) are grouped together within the trigeminal autonomic cephalalgias (TACs). However, the SUNCT and SUNA phenotype and management overlap with those of trigeminal neuralgia (TN). Additionally, a broad variety of cerebral pathologies are reportedly able to trigger either TN- or SUNCT-like pain, and emerging structural neuroimaging findings suggest the possible role of neurovascular conflict with the trigeminal nerve in SUNCT, further supporting aetiological and pathophysiological overlaps among SUNCT, SUNA and TN. Case report We present the first case of coexisting chronic SUNCT- and TN-like phenotypes caused by haemorrhagic infarct of the dorsolateral medulla. Discussion In light of our case, a perturbation of the dorsolateral medullary circuits may constitute an important pathophysiological component, supporting a unifying nosological hypothesis that considers SUNCT, SUNA and TN clinical variants of the same disorder.

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Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: A prospective systematic study using independent assessors

Cephalalgia ◽

10.1177/0333102418783294 ◽

2018 ◽

Vol 39 (2) ◽

pp. 197-208 ◽

Cited By ~ 8

Author(s):

Tone Bruvik Heinskou ◽

Per Rochat ◽

Stine Maarbjerg ◽

Frauke Wolfram ◽

Jannick Brennum ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Odds Ratio ◽

Morphological Changes ◽

Outcome Data ◽

Excellent Outcome ◽

Classical Trigeminal Neuralgia ◽

Male Sex ◽

Symptomatic Side

Introduction There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16–16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12–59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration. Conclusion Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.

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Trigeminal Neuralgia with Lacrimation Or Sunct Syndrome?

Cephalalgia ◽

10.1046/j.1468-2982.1998.1802085.x ◽

1998 ◽

Vol 18 (2) ◽

pp. 85-90 ◽

Cited By ~ 65

Author(s):

R Benoliel ◽

Y Sharav

Keyword(s):

Differential Diagnosis ◽

Trigeminal Neuralgia ◽

Clinical Signs ◽

Signs And Symptoms ◽

Intimate Relationship ◽

The Other ◽

Conjunctival Injection ◽

Sunct Syndrome ◽

Clinical Signs And Symptoms

An intimate relationship between trigeminal neuralgia (TN) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome, based on similar clinical signs and symptoms and on cases demonstrating possible “transformation” from one entity to the other, has been widely accepted. We evaluated the presence of lacrimation in 22 consecutive cases that had been diagnosed as TN. Ipsilateral lacrimation was reported by 6 such cases (5M, 1F). These cases responded to antineuralgic therapy with concomitant resolution of lacrimation and were clinically very similar to TN. The differential diagnosis and the possibility of lacrimation in TN are discussed.

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Leveraging high-resolution 7-tesla MRI to derive quantitative metrics for the trigeminal nerve and subnuclei of limbic structures in trigeminal neuralgia

The Journal of Headache and Pain ◽

10.1186/s10194-021-01325-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Judy Alper ◽

Alan C. Seifert ◽

Gaurav Verma ◽

Kuang-Han Huang ◽

Yael Jacob ◽

...

Keyword(s):

High Resolution ◽

Trigeminal Neuralgia ◽

Trigeminal Nerve ◽

7 Tesla ◽

Pain Processing ◽

Limbic Structure ◽

Limbic Structures ◽

Structural Alterations ◽

7 Tesla Mri ◽

Symptomatic Side

Abstract Background Trigeminal Neuralgia (TN) is a chronic neurological disease that is strongly associated with neurovascular compression (NVC) of the trigeminal nerve near its root entry zone. The trigeminal nerve at the site of NVC has been extensively studied but limbic structures that are potentially involved in TN have not been adequately characterized. Specifically, the hippocampus is a stress-sensitive region which may be structurally impacted by chronic TN pain. As the center of the emotion-related network, the amygdala is closely related to stress regulation and may be associated with TN pain as well. The thalamus, which is involved in the trigeminal sensory pathway and nociception, may play a role in pain processing of TN. The objective of this study was to assess structural alterations in the trigeminal nerve and subregions of the hippocampus, amygdala, and thalamus in TN patients using ultra-high field MRI and examine quantitative differences in these structures compared with healthy controls. Methods Thirteen TN patients and 13 matched controls were scanned at 7-Tesla MRI with high resolution, T1-weighted imaging. Nerve cross sectional area (CSA) was measured and an automated algorithm was used to segment hippocampal, amygdaloid, and thalamic subregions. Nerve CSA and limbic structure subnuclei volumes were compared between TN patients and controls. Results CSA of the posterior cisternal nerve on the symptomatic side was smaller in patients (3.75 mm2) compared with side-matched controls (5.77 mm2, p = 0.006). In TN patients, basal subnucleus amygdala volume (0.347 mm3) was reduced on the symptomatic side compared with controls (0.401 mm3, p = 0.025) and the paralaminar subnucleus volume (0.04 mm3) was also reduced on the symptomatic side compared with controls (0.05 mm3, p = 0.009). The central lateral thalamic subnucleus was larger in TN patients on both the symptomatic side (0.033 mm3) and asymptomatic side (0.035 mm3), compared with the corresponding sides in controls (0.025 mm3 on both sides, p = 0.048 and p = 0.003 respectively). The inferior and lateral pulvinar thalamic subnuclei were both reduced in TN patients on the symptomatic side (0.2 mm3 and 0.17 mm3 respectively) compared to controls (0.23 mm3, p = 0.04 and 0.18 mm3, p = 0.04 respectively). No significant findings were found in the hippocampal subfields analyzed. Conclusions These findings, generated through a highly sensitive 7 T MRI protocol, provide compelling support for the theory that TN neurobiology is a complex amalgamation of local structural changes within the trigeminal nerve and structural alterations in subnuclei of limbic structures directly and indirectly involved in nociception and pain processing.

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MAGNETIC RESONANCE CHARACTERISTICS OF THE NEUROVASCULAR RELATIONSHIP AS A PROBABLE PREDICTOR OF TRIGEMINAL NEURALGIA

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2018-99-5-231-236 ◽

2018 ◽

Vol 99 (5) ◽

pp. 231-236

Author(s):

A. V. Bakunovich ◽

V. E. Sinitsyn ◽

E. A. Mershina

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Posterior Cranial Fossa ◽

Control Group ◽

Slice Thickness ◽

Healthy Individuals ◽

Study Population ◽

Cranial Fossa ◽

And Control ◽

Symptomatic Side

Objective.To validate MR-criteria used for diagnosis of trigeminal neuralgia (TN).Material and methods.Study population consisted of 133 patients: with trigeminal neuralgia (86, surgically (56) and clinically (30) verified; 55 ± 11 years) and control group (47; 51 ± 16 years). The data were obtained using the FIESTA sequence (slice thickness 0.5 mm) on 3T and 1.5T (Discovery 750w and Optima 450w, General Electric).Results.The diameters of the adjacent vessels on the symptomatic side were significantly bigger than the diameters on the asymptomatic side in patients with neuralgia (medians 1.2 and 1 mm, p<0.001). The shortest distances between nerves and vessels on the symptomatic side were significantly smaller than the distances on the asymptomatic side (medians 0 and 1.6 mm, p<0.001). The distances between points of closest neurovascular contact and pons on the symptomatic side were significantly smaller in comparison with the controls (medians 2.7 and 5.3 mm, p<0.001); the distances between the symptomatic and asymptomatic side were not statistically different (medians 2.7 and 3.9 mm, p=0.09) in this parameter. The lengths of closest neurovascular contact was bigger in patient with TN (medians 3 and 0 mm, p<0.05), as well as in comparison with the asymptomatic side (medians 3 and 0 mm, p<0.0001).Conclusion.Noninvasive MR-measurements of the posterior cranial fossa vessels show the differences between the symptomatic and asymptomatic side in the patients with TN as well as healthy individuals. This result may be used as a predictor of TN.

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Short-Lasting Unilateral Neuralgiform Headache Attacks with Tearing and Conjunctival Injection: The First “Symptomatic” Case?

Cephalalgia ◽

10.1046/j.1468-2982.1991.1103123.x ◽

1991 ◽

Vol 11 (3) ◽

pp. 123-127 ◽

Cited By ~ 69

Author(s):

Gennaro Bussone ◽

Massimo Leone ◽

Giorgio Dalla Volta ◽

Liliana Strada ◽

Roberto Gasparotti ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Arteriovenous Malformation ◽

Cluster Headache ◽

Clinical Picture ◽

Cerebellopontine Angle ◽

Conjunctival Injection ◽

Careful Evaluation ◽

Symptomatic Case

A 36-year-old man was suffering from brief, unilateral and short-lasting pain attacks always associated with marked homolateral tearing and conjunctival injection, both presenting in a cluster fashion. An arteriovenous malformation was subsequently discovered in the homolateral cerebellopontine angle. The clinical picture shares similarities with both cluster headache and trigeminal neuralgia, although it can not be accurately placed with either of these forms. Patients with similar symptoms have previously been described in detail, and on the basis of these few descriptions a new syndrome “short-lasting” unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhoea has been postulated. Assuming the validity of this syndrome as an entity, this case is in all probability its first “symptomatic” example. Careful evaluation of the varieties of cluster headache and trigeminal neuralgia, and the reporting of similar new cases as they arise are necessary to establish the nosologic boundaries of this syndrome.

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