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Trigeminal Neuralgia Diagnosis: Based on the location and nature of pain, no other other neurological symptoms and signs. Should have the following four characteristics:
(1) the onset of pain pain gap.
(2) no clear positive signs of nervous system
(3) the trigger point
(4) strictly limit the pain of trigeminal nerve region.
Here were introduced pain, atypical face pain, sinus, glossopharyngeal neuralgia, in the middle neuralgia, sphenopalatine neuralgia, cluster, pain, trigeminal neuralgia and trigeminal neuralgia secondary identification.
(1) pain: trigeminal neuralgia is often misdiagnosed as toothache, pain after tooth extraction some patients before diagnosis. Persistent pain was generally dull, and more confined to the gingival, into the hot and cold food can be increased, local and radiological examination can be identified.
(2) atypical face pain: to occur in patients with depression and nervousness, pain fuzzy variable, usually on both sides, emotions are the only aggravating factor, face no trigger points.
(3) sinusitis: Local persistent dull pain, tenderness, often fever, increased white blood cells, pus and other inflammation, nasal examination and x-ray film can be confirmed.
(4), glossopharyngeal neuralgia: the pain of trigeminal neuralgia the same nature, easy to support with the pain of trigeminal nerve section III mixed. Glossopharyngeal neuralgia in the side of the base of the tongue position, soft palate, tonsils and throat, a few expressed as ear pain, but more deep in the ear or ears. If the 4% cocaine spray in the throat, the pain disappears diagnosis. In addition, some of glossopharyngeal neuralgia may be associated with trigeminal neuralgia, to be correctly identified.
(5) showed the side of the middle neuralgia external auditory canal, mastoid burning, the local may have shingles, in addition, peripheral facial paralysis can see, taste and hearing loss. Episodes of pain of the disease longer, and might to the face, the outer edge of the tongue, throat and neck radiation.
(6), sphenopalatine neuralgia pain attack nasal congestion, obstruction, tearing, pain limited to the lower face may be directed to the neck, shoulder, upper extremity radiation. Do sphenopalatine ganglion anesthesia (4% cocaine with cotton pad over fill the back end of the middle turbinate) to stop the pain.
(7) cluster pain on one side of the disease also showed facial pain, mainly in the eye, temporal. The disease attacks a long time, may be associated with facial flushing, conjunctival hyperemia, tearing, local sweating and the slow pulse, and the superficial temporal artery pulse obvious. Effective use of antihistamine.
(8) secondary trigeminal neuralgia: trigeminal nerve palsy usually presents and persistent pain, associated with other cranial nerve palsy, secondary trigeminal neuralgia, common cause the following diseases:
① cerebellopontine angle tumor: a cholesteatoma, acoustic neuroma, meningioma common. These tumors may only occur early trigeminal neuralgia, with the tumor increases, there may be V, VII, VIII, IX and other cranial nerve damage performance. For trigeminal neuralgia, cranial nerve damage associated with these patients should be suspected cerebellopontine angle tumors, CT or MRI in time-line and other tests for early diagnosis or treatment.
② cerebral arachnoiditis: the limitations of arachnoiditis skull base violation of the trigeminal nerve can cause facial pain, mostly persistent dull pain, sensory disturbance associated with pain location.
③ skull base malignancies: more common oral cancer and nasopharyngeal cancer, metastatic carcinoma or sarcoma occasionally such as skull base. A wide range of facial pain, often over the trigeminal nerve distribution area. Pain is persistent, and visible performance of a wide range of cranial nerve damage, often accompanied by epistaxis, nasal obstruction.
④ semilunar ganglion of trigeminal nerve tumors: see ganglion cell tumor, chordoma and so on. Trigeminal sensory and motor deficits significantly, X-ray examination may have a base of the skull bone destruction.
⑤ multiple sclerosis: 1% of trigeminal neuralgia can occur in patients with multiple sclerosis. For bilateral trigeminal neuralgia, multiple sclerosis patients should be alert to the possibility.
⑥ postherpetic neuralgia: trigeminal nerve occur in Article I branch area, was sustained burning, herpes subsided in a few days, months or even years after. District may have white skin pain, sensory disturbance. Of such patients should be asked in detail about history, to make a clear diagnosis.
⑦ nerve injury, trigeminal neuralgia after surgery: half section of the trigeminal nerve root damage and cut off the operation after a small number of numbness can occur in patients with pain, trigeminal nerve tract off higher rate of postoperative, pain, sensory disturbance area, pain into sustainability.
(1) the onset of pain pain gap.
(2) no clear positive signs of nervous system
(3) the trigger point
(4) strictly limit the pain of trigeminal nerve region.
Here were introduced pain, atypical face pain, sinus, glossopharyngeal neuralgia, in the middle neuralgia, sphenopalatine neuralgia, cluster, pain, trigeminal neuralgia and trigeminal neuralgia secondary identification.
(1) pain: trigeminal neuralgia is often misdiagnosed as toothache, pain after tooth extraction some patients before diagnosis. Persistent pain was generally dull, and more confined to the gingival, into the hot and cold food can be increased, local and radiological examination can be identified.
(2) atypical face pain: to occur in patients with depression and nervousness, pain fuzzy variable, usually on both sides, emotions are the only aggravating factor, face no trigger points.
(3) sinusitis: Local persistent dull pain, tenderness, often fever, increased white blood cells, pus and other inflammation, nasal examination and x-ray film can be confirmed.
(4), glossopharyngeal neuralgia: the pain of trigeminal neuralgia the same nature, easy to support with the pain of trigeminal nerve section III mixed. Glossopharyngeal neuralgia in the side of the base of the tongue position, soft palate, tonsils and throat, a few expressed as ear pain, but more deep in the ear or ears. If the 4% cocaine spray in the throat, the pain disappears diagnosis. In addition, some of glossopharyngeal neuralgia may be associated with trigeminal neuralgia, to be correctly identified.
(5) showed the side of the middle neuralgia external auditory canal, mastoid burning, the local may have shingles, in addition, peripheral facial paralysis can see, taste and hearing loss. Episodes of pain of the disease longer, and might to the face, the outer edge of the tongue, throat and neck radiation.
(6), sphenopalatine neuralgia pain attack nasal congestion, obstruction, tearing, pain limited to the lower face may be directed to the neck, shoulder, upper extremity radiation. Do sphenopalatine ganglion anesthesia (4% cocaine with cotton pad over fill the back end of the middle turbinate) to stop the pain.
(7) cluster pain on one side of the disease also showed facial pain, mainly in the eye, temporal. The disease attacks a long time, may be associated with facial flushing, conjunctival hyperemia, tearing, local sweating and the slow pulse, and the superficial temporal artery pulse obvious. Effective use of antihistamine.
(8) secondary trigeminal neuralgia: trigeminal nerve palsy usually presents and persistent pain, associated with other cranial nerve palsy, secondary trigeminal neuralgia, common cause the following diseases:
① cerebellopontine angle tumor: a cholesteatoma, acoustic neuroma, meningioma common. These tumors may only occur early trigeminal neuralgia, with the tumor increases, there may be V, VII, VIII, IX and other cranial nerve damage performance. For trigeminal neuralgia, cranial nerve damage associated with these patients should be suspected cerebellopontine angle tumors, CT or MRI in time-line and other tests for early diagnosis or treatment.
② cerebral arachnoiditis: the limitations of arachnoiditis skull base violation of the trigeminal nerve can cause facial pain, mostly persistent dull pain, sensory disturbance associated with pain location.
③ skull base malignancies: more common oral cancer and nasopharyngeal cancer, metastatic carcinoma or sarcoma occasionally such as skull base. A wide range of facial pain, often over the trigeminal nerve distribution area. Pain is persistent, and visible performance of a wide range of cranial nerve damage, often accompanied by epistaxis, nasal obstruction.
④ semilunar ganglion of trigeminal nerve tumors: see ganglion cell tumor, chordoma and so on. Trigeminal sensory and motor deficits significantly, X-ray examination may have a base of the skull bone destruction.
⑤ multiple sclerosis: 1% of trigeminal neuralgia can occur in patients with multiple sclerosis. For bilateral trigeminal neuralgia, multiple sclerosis patients should be alert to the possibility.
⑥ postherpetic neuralgia: trigeminal nerve occur in Article I branch area, was sustained burning, herpes subsided in a few days, months or even years after. District may have white skin pain, sensory disturbance. Of such patients should be asked in detail about history, to make a clear diagnosis.
⑦ nerve injury, trigeminal neuralgia after surgery: half section of the trigeminal nerve root damage and cut off the operation after a small number of numbness can occur in patients with pain, trigeminal nerve tract off higher rate of postoperative, pain, sensory disturbance area, pain into sustainability.
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