Cases reported "trigeminal neuralgia"

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1/436. Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy: case report.

    BACKGROUND: Trigeminal sensory neuropathy is often associated with facial idiopathic nerve paralysis (Bell's palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remains unclear. This case report of recovery of both trigeminal and facial neuropathy after surgical decompression of the facial nerve suggests an anatomic link. methods: A case of a 39-year-old woman presenting with recurrent unilateral facial paralysis is summarized. Her fifth episode, which did not spontaneously recover, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS: A middle cranial fossa approach for decompression of the lateral internal auditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient's pain and numbness resolved immediately postoperatively, and the facial paralysis improved markedly. CONCLUSION: This result implicates a trigeminal-facial reflex as hypothesized by others. It suggests that decompression of the facial nerve can lead to improvement in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction. ( info)

2/436. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.

    BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. methods: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery. ( info)

3/436. Acute herpetic neuralgia and postherpetic neuralgia in the head and neck: response to gabapentin in five cases.

    BACKGROUND AND OBJECTIVES: The clinical presentations and pharmacologic management of three patients with acute herpetic neuralgia (AHN) and two patients with postherpetic neuralgia (PHN), confined to the head and neck region, are described. methods: Two patients had pain in the ophthalmic division of the trigeminal nerve, two had pain confined to the C2-C4 dermatomes, and one patient had C2 pain with radiating and referred pain to the second and third divisions of the trigeminal nerve. RESULTS: Gabapentin, an anticonvulsant drug, was effective in treating these patients, including the two cases of AHN. All patients reported complete pain relief after titration with gabapentin up to 1,800 mg/d. The patients noted a dose-dependent decrease in pain almost immediately after starting gabapentin. Specifically, reduction in the frequency and intensity of allodynia, burning pain, shooting pain, and throbbing pain were noted. None of the patients experienced side effects from the drug. CONCLUSIONS: In view of the results in these patients, blinded, controlled studies are needed to determine the efficacy of gabapentin for treating AHN and PHN. ( info)

4/436. Surgical treatment of recurrent trigeminal neuralgia.

    In this retrospective investigation 7 patients operated on for recurrent trigeminal neuralgia via a suboccipital enlarged burr hole trepanation were evaluated. The intraoperative findings indicate that neo-compressive effects due to foreign material used during prior surgery are more important than adhesions around the nerve. Furthermore, the results of recurrent operations are encouraging as 6 of the 7 patients were painfree without additional neurological deficits. ( info)

5/436. Arnold Chiari Type I malformation presenting as a trigeminal neuralgia: case report.

    OBJECTIVE AND IMPORTANCE: Arnold Chiari Type I malformation usually presents as headache, arm numbness, dysesthesia, upper weakness, or gait difficulty. We report a case of Chiari malformation presenting as a left trigeminal neuralgia. CLINICAL PRESENTATION: A patient with a history of 29 years of trigeminal neuralgia was admitted. He was treated with three thermocoagulations. Microvascular decompression was planified. magnetic resonance imaging was performed, and it demonstrated an Arnold Chiari malformation. After surgery, the patient was asymptomatic. INTERVENTION: Posterior fossa decompression by enlarging the foramen magnum and aspiration of the cerebellar tonsils was performed. CONCLUSION: The trigeminal neuralgia could be attributable to a compression of the trigeminal nucleus. The compression of the nucleus could explain both the pain and the regression after surgery. This is the second reported case of pure trigeminal neuralgia in Arnold Chiari malformation. ( info)

6/436. trigeminal neuralgia. New treatment options for a well-known cause of facial pain.

    trigeminal neuralgia is an idiopathic disorder of unilateral facial pain that is characterized by lancinating paroxysms of pain in the lips, gums, cheek, or chin. Pain in trigeminal neuralgia is associated with physical triggers. Much of the treatment has been unchanged for more than 10 years, with cabamazepine being the standard first-line treatment. There are several promising new medications available, such as pimozide, tizanidine hydrochloride, and topical capsaicin. Surgical management is also effective. ( info)

7/436. trigeminal neuralgia triggered by auditory stimuli in multiple sclerosis.

    OBJECTIVES: To describe a patient with a demyelinating brainstem lesion who developed right-sided trigeminal neuralgia triggered by auditory stimuli and to discuss the pathophysiological mechanisms underlying this unusual phenomenon. DESIGN: Case report. SETTING: Referral center. PATIENT: A 27-year-old man who presented with clinical signs of a brainstem lesion developed right-sided trigeminal neuralgia triggered by auditory stimuli to the right ear. magnetic resonance imaging and electrophysiological studies demonstrated a demyelinating lesion in the pons affecting the right lateral lemniscus and the right trigeminal pathway. This phenomenon completely subsided within 4 days. After a relapse, the diagnosis of clinically definite multiple sclerosis was made. CONCLUSION: Lateral spread of impulse activity within the demyelinating pontine lesion is the likely explanation for the unusual phenomenon of trigeminal neuralgia triggered by auditory stimuli. ( info)

8/436. Persistent trigeminal neuralgia after removal of contralateral posterior cranial fossa tumor. Report of two cases.

    BACKGROUND: Contralateral trigeminal neuralgia as a false localizing sign in patients with posterior cranial fossa tumors is rare. Persistent contralateral trigeminal neuralgia after removal of the posterior fossa expanding lesion with microsurgical exploration of the affected trigeminal nerve root has been described in only a few reports. Displacement of the brainstem and the trigeminal nerve root, arachnoid adhesions, and vascular compression of the nerve root entry zone have been reported as causes of persistent contralateral trigeminal neuralgia. methods: One patient developed transformation of the contralateral constant burning facial pain into trigeminal neuralgia after removal of a posterior fossa meningioma. A typical right-sided tic douloureux in our second patient did not disappear after removal of a left acoustic neurinoma. CT scan revealed brainstem displacement to the side of trigeminal neuralgia. Microsurgical exploration in both cases demonstrated the squeezed and distorted trigeminal nerve root and displaced brain stem with no vascular involvement. Both patients underwent partial trigeminal rhizotomy for pain control. RESULTS: Complete disappearance of the trigeminal neuralgia was evident in both cases with postoperative facial sensory loss. The postoperative course in the first case was uneventful; the second patient died from purulent meningoencephalitis. CONCLUSION: Persistent contralateral trigeminal neuralgia after removal of a posterior fossa tumor is caused by distortion of the fifth nerve root by the displaced brainstem. Partial trigeminal rhizotomy can be performed for alleviation of facial neuralgic pain in cases without neurovascular compression. ( info)

9/436. Removal of petrous apex meningioma and microvascular decompression for trigeminal neuralgia through the anterior petrosal approach. Case report.

    A 64-year-old female presented with right trigeminal neuralgia. Computed tomography and magnetic resonance (MR) imaging demonstrated a tumor attached to the right petrous apex. MR imaging also revealed that the trigeminal nerve was compressed and distorted by the tumor. Tumor removal and microvascular decompression (MVD) were performed via the anterior petrosal approach. The trigeminal nerve was distorted by the tumor and the superior cerebellar artery compressed the medial part of the root entry zone of the trigeminal nerve. The surgery resulted in complete relief of the trigeminal neuralgia. Posterior fossa tumors causing ipsilateral trigeminal neuralgia are not rare, and are often removed via the suboccipital retromastoid approach, as MVD for trigeminal neuralgia is usually performed through the retromastoid approach. The advantages of the anterior petrosal approach are shorter access to the lesion and direct exposure without interference from the cranial nerves, and that bleeding from the tumors is easily controlled as the feeding arteries can be managed in the early stage of the surgery. We conclude that the anterior petrosal approach is safe and advantageous for the removal of petrous apex tumor associated with trigeminal neuralgia. ( info)

10/436. Familial trigeminal neuralgia and contralateral hemifacial spasm.

    A patient was evaluated with familial trigeminal neuralgia (TN) and contralateral hemifacial spasm. The mother of the patient, 5 of 10 siblings, and 1 nephew also had TN confirmed by neurologists. The transmission of TN was suggestive of an autosomal dominant inheritance. This family provides additional evidence of a genetic basis for TN in selected cases and also provokes further speculation on a common unifying hypothesis of pathophysiology in cranial rhizopathies. ( info)
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