Role of patient history and physical examination in the diagnosis of trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Kenneth F. Casey
Keyword(s):  
Primary Care ◽  
Trigeminal Neuralgia ◽  
Physical Examination ◽  
Facial Pain ◽  
Patient History ◽  
Simple Scheme ◽  
Care Givers ◽  
Patient’S History

The diagnosis of facial pain has been a source of confusion for neuroscientists and primary care givers alike. The profusion of various subtypes, differential syndromes, and confusing nomenclature is silent testimony to this dilemma. The author presents a simple scheme with which to arrive at the diagnosis. The use of the patient's history, confirmed by the physical examination, can be supplemented with some of the tests described herein.

Idiopathic Trigeminal Neuralgia: A Case Report

2018 ◽  
Vol 31 (04) ◽  
pp. 254-258
Author(s):  
Shruti Jain ◽  
Chetna Lamba
Keyword(s):  
Case Report ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Conventional Medicine ◽  
Positive Role ◽  
Idiopathic Trigeminal Neuralgia ◽  
Adequate Pain Relief ◽  
The Face

AbstractTrigeminal neuralgia (TN) is the most frequent type of neuropathic facial pain affecting one or more branches of trigeminal nerve. Here, a 51-year-old woman diagnosed with idiopathic trigeminal neuralgia (ITN) presented with complaints of pain over right side of the face with redness of the eyes and excessive lachrymation since 5 years with weekly acute episodes of shooting pain. Chelidonium was chiefly prescribed followed by few doses of Spigelia as per indications which provided adequate pain relief. The complaints flared up following stressful circumstances for which Pulsatilla was prescribed after detailed case taking. The frequency, duration and intensity of pain reduced after homoeopathic treatment. The need for conventional medicine was also reduced. This suggests positive role of individualised homoeopathy in the treatment of ITN. Further studies should be undertaken to evaluate the role of homoeopathy in ITN.

scholarly journals Vertebrobasilar dolichoectasia as a cause of trigeminal neuralgia: the role of microvascular decompression. Case report

2006 ◽  
Vol 64 (1) ◽  
pp. 128-131 ◽  
Author(s):  
Jorge Luiz Kraemer ◽  
Arthur de Azambuja Pereira Filho ◽  
Gustavo de David ◽  
Mario de Barros Faria
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Successful Outcome ◽  
Mechanical Compression ◽  
Suboccipital Craniotomy ◽  
Vertebrobasilar Dolichoectasia

Our purpose is to report a case of trigeminal neuralgia caused by vertebrobasilar dolichoectasia treated with microvascular decompression. A 63-year-old man sought treatment for a recurrent lancinating left facial pain in V2 and V3 trigeminal territories. The computed tomography angiography revealed a mechanical compression of the left trigeminal nerve due to vertebrobasilar dolichoectasia. The patient was submitted to a left suboccipital craniotomy. Shredded Teflon® was introduced in the conflicting neurovascular area, achieving a satisfactory decompression. The patient’s pain resolved immediately. Vertebrobasilar dolichoectasia is a rare cause of trigeminal neuralgia and a successful outcome can be achieved with microvascular decompression.

A New Classification for Facial Pain

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1164-1167 ◽  
Author(s):  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Classification Scheme ◽  
Unintentional Injury ◽  
Atypical Facial Pain ◽  
New Classification ◽  
Somatoform Pain Disorder ◽  
Constant Pain ◽  
Diagnostic Labels ◽  
Patient’S History

Abstract PURPOSE A patient-oriented classification scheme for facial pains commonly encountered in neurosurgical practice is proposed. CONCEPT This classification is driven principally by the patient's history. RATIONALE The scheme incorporates descriptions for so-called “atypical” trigeminal neuralgias and facial pains but minimizes the pejorative, accepting that the physiology of neuropathic pains could reasonably encompass a variety of pain sensations, both episodic and constant. Seven diagnostic labels result: trigeminal neuralgia Types 1 and 2 refer to patients with the spontaneous onset of facial pain and either predominant episodic or constant pain, respectively. Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery, whereas trigeminal deafferentation pain results from injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an intentional attempt to treat either trigeminal neuralgia or other facial pain. Postherpetic neuralgia follows a cutaneous herpes zoster outbreak (shingles) in the trigeminal distribution, and symptomatic trigeminal neuralgia results from multiple sclerosis. The final category, atypical facial pain, is synonymous with facial pain secondary to a somatoform pain disorder. Atypical facial pain can be suspected but not diagnosed by history and can be diagnosed only with detailed and objective psychological testing. CONCLUSION This diagnostic classification would allow more rigorous and objective natural history and outcome studies of facial pain in the future.

scholarly journals Trigeminal neuralgia: definition and classification

2005 ◽  
Vol 18 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Jorge L. Eller ◽  
Ahmed M. Raslan ◽  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Classification Scheme ◽  
Unintentional Injury ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain ◽  
Somatoform Pain Disorder ◽  
Pain Syndromes ◽  
Specific Objective ◽  
Patient’S History

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

scholarly journals Nutritional Laboratory Markers in Malnutrition

2019 ◽  
Vol 8 (6) ◽  
pp. 775 ◽  
Author(s):  
Ulrich Keller
Keyword(s):  
Nutritional Status ◽  
Physical Examination ◽  
Muscle Protein ◽  
Laboratory Markers ◽  
Protein Energy ◽  
Rapid Changes ◽  
Energy Stores ◽  
Concentration Changes ◽  
Patient’S History

Serum visceral proteins such as albumin and prealbumin have traditionally been used as markers of the nutritional status of patients. Prealbumin is nowadays often preferred over albumin due to its shorter half live, reflecting more rapid changes of the nutritional state. However, recent focus has been on an appropriate nutrition-focused physical examination and on the patient’s history for diagnosing malnutrition, and the role of inflammation as a risk factor for malnutrition has been more and more recognized. Inflammatory signals are potent inhibitors of visceral protein synthesis, and the use of these proteins as biomarkers of the nutritional status has been debated since they are strongly influenced by inflammation and less so by protein energy stores. The current consensus is that laboratory markers could be used as a complement to a thorough physical examination. Other markers of the nutritional status such as urinary creatinine or 3-methylhistidine as indicators of muscle protein breakdown have not found widespread use. Serum IGF-1 is less influenced by inflammation and falls during malnutrition. However, its concentration changes are not sufficiently specific to be useful clinically as a marker of malnutrition, and serum IGF-1 has less been used in clinical trials. Nevertheless, biomarkers of malnutrition such as prealbumin may be of interest as easily measurable predictors of the prognosis for surgical outcomes and of mortality in severe illnesses.

scholarly journals Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Haldor Slettebø
Keyword(s):  
Retrospective Study ◽  
Trigeminal Neuralgia ◽  
Physical Examination ◽  
Facial Pain ◽  
Low Grade ◽  
Clinical Criteria ◽  
Neurosurgical Treatment ◽  
Mri Scans ◽  
First Time ◽  
Dental Conditions

Abstract Objectives Patients with facial pain are sometimes referred for neurosurgical treatment with a poorly documented diagnosis of trigeminal neuralgia. In such cases, neurosurgery will usually not be helpful. We conducted a re-evaluation of the diagnosis in patients referred for neurosurgical treatment of presumed trigeminal neuralgia. Our objective was to find out why and how often misdiagnosis occurred. Methods A retrospective study was done in consecutive first-time patients referred for trigeminal neuralgia to our outpatient clinic in 2019. We used five ICHD-3-based clinical criteria to verify or exclude the diagnosis. In patients where trigeminal neuralgia was excluded, we established a diagnosis for their facial pain based upon medical history and a physical examination by a neurosurgeon – often supplemented with examination by an oral surgeon. Results Thirty-eight patients were referred for presumed trigeminal neuralgia. Only 17 of them fulfilled the five criteria and were diagnosed with trigeminal neuralgia. In 20 of the remaining 21 patients trigeminal neuralgia could be clearly excluded, while one of the patients had a periodontitis closely mimicking trigeminal neuralgia. In 14 of the 21 patients we diagnosed temporomandibular dysfunction or dental conditions. MRI scans had detected low-grade neurovascular contacts in 13 of the 21 patients, a finding that was clearly overestimated by the referring neurologists in seven patients. Conclusions Overdiagnosis of trigeminal neuralgia was common in patients referred for neurosurgery, mostly due to insufficient clinical evaluation combined with an overestimation of MRI-detected NVCs. The clinical diagnosis should be critically re-evaluated before recommending neurosurgery to patients referred for presumed trigeminal neuralgia.

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