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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve chemical rhyzolisis (surgical instilation of 10 c.c. of 15% NaCl solution) of trigeminal nerve were performed in 11 patients with trigeminal neuralgia resistent to medical treatment. Before and at least in the first 30 minutes after instilation the following parameters were monitorized: electrocardiogram, electroencephalogram, intrarradial arterial pressure and venous central pressure. In 10 cases after a 2.8 +/- 2.4 seg. latency period the following arrhythmias appeared (in paragraphs number of cases): sinus bradicardia, sinoauricular block, sinus arrest, atrial-ventricular block and atrial pacemaker migration. During sinus arrest (8 episodes in 4 cases; mean duration 17.6 secs.) slow, high voltage waves appeared in the electroencephalographic tracings. Ventricular scapes were not seen at the end of the sinus pauses. In 6 cases after this slow arrhythmic phase the following arrhythmias were observed: ventricular premature beats, atrial premature beats, sinus tachycardia, bidirectional ventricular tachycardia, and nodal tachycardia. All cases exhibited an elevation of mean arterial pressure after instilation of the nerve which was preceded by a short period of hypertension in 4 occasions. Average and standard deviations changes of systolic, diastolic and mean blood pressure (mm of Hg), pulse (beats/minute) and central venous pressure (cms of H2O) during the procedure were 46.7 +/- 29.3, 23.0 +/- 13.3, 34.1 +/- 16.4, 25.8 +/- 16.2 and 6.6 +/- 5.8, respectively (p less than or equal to 0.001) in all changes but the last ones, less than or equal to 0.05). Physiopathologic considerations of this autonomic crises are done.
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PMID:[Cardiovascular manifestations of chemical rhysolisis of the trigeminal nerve]. 54 21

The overall crude incidence rate of trigeminal neuralgia per 100,000 population in Rochester, Minnesota, for 1945 through 1984 was 4.3 for both sexes combined. The age-adjusted (to total 1980 US population) rate for women (5.9) was significantly higher than that for men (3.4). Annual incidence rates increased significantly with age in both women and men. Data based on evidence in the medical records suggest that trigeminal neuralgia is a rather rare and unpredictable disease: The number of episodes varies from 1 to 11, and length of episode from 1 day to 4 years. This study indicates an elevated relative risk associated with hypertension (both overall and among women in the cohort). Also, prevalence of multiple sclerosis was significantly greater among the group of 75 patients who had trigeminal neuralgia. Since the data on treatment in this study do not correspond to a randomized clinical trial, they are presented as empirical results only and show no single treatment of choice for trigeminal neuralgia.
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PMID:Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. 230 31

Thirty-five patients with trigeminal neuralgia (TN) bilaterally underwent posterior fossa microvascular decompression (MVD) between 1971 and 1984. They comprised 5.0% of a larger series of 699 patients with TN who underwent MVD during that interval. Compared to the subgroup of 664 patients with only unilateral symptoms, the population with bilateral TN included a greater percentage of females (74% vs. 58%, p less than 0.1), a higher rate of "familial" TN (17% vs. 4.1%, p less than 0.001), and an increased incidence of additional cranial nerve dysfunction (17% vs. 6.6%, p less than 0.05) and hypertension (34% vs. 19%, p less than 0.05). Of the 35 patients with bilateral TN, 10 underwent bilateral MVD (22 procedures) and 25 underwent unilateral MVD (30 procedures). In the latter patients, pain on the nonoperative side was well controlled with medication alone or had previously been treated by ablative procedures. Good or excellent pain control was achieved after one MVD was performed in 40 of the 45 sides treated (89%), and was maintained 1, 5, and 10 years after surgery in 82%, 66%, and 60%, respectively, based on life-table analysis. Six of 10 patients with recurrent symptoms underwent repeat unilateral MVD. Good or excellent long-term pain control was maintained in all six. With these repeat procedures included, symptom control at 1, 5, and 10 years after initial surgery was maintained in 87%, 78%, and 78% of the treated sides, respectively. Overall, 26 of 35 patients (74%) maintained good or excellent pain relief throughout the duration of the study (mean follow-up period 75 months) without resumption of regular medication usage. Although preoperative neurological deficits resulting from previous ablative procedures were seen in the majority of patients before MVD, no patient developed new major trigeminal sensory loss or masseter weakness after MVD. Operative mortality was zero. The results indicate that posterior fossa MVD is an effective and relatively safe treatment for the majority of patients with bilateral "idiopathic" TN, avoiding the risks of bilateral trigeminal nerve injury seen with other approaches.
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PMID:Bilateral trigeminal neuralgia: a 14-year experience with microvascular decompression. 245 Sep 74

Twenty nine patients with trigeminal neuralgia were treated by retrogasserian glycerol injection method. Two of 29 were postherpetic and 27 were idiopathic trigeminal neuralgia. The mean age of these 27 was 65.2 years old ranging from 35 to 83 and the mean duration of symptoms was 7.6 years ranging from 6 months to 25 years. As previous surgical treatment there were 9 alcohol block, 5 thermorhizotomy of the Gasserian ganglion and one microvascular decompression. Twenty-two gauge needle was introduced into the trigeminal cistern via foramen ovale under the fluoroscopic control. Before injection of glycerol trigeminal cisternography using metrizamide of 300 mgI/dl was done to ascertain whether or not the needle tip was properly placed in the cistern. Patients' neck being flexed anteriorly, pure glycerol, amounting from 0.15 to 0.6 ml, was injected into the cistern with small increments through the needle. If the needle was inserted too deeply in the cistern, it is more probable that glycerol should escape from the cistern into the posterior fossa. So it was advisable that needle tip should be placed in the bottom of the cistern. When there was no pain relief, second injection was performed usually 7 days after the first injection. Complications were as follows; dysesthesia (81%), hypertension (70%), hypalgesia and hypesthesia (48%) headache (22%), ocular dysesthesia (11%), masseter weakness (7%), hyperalgesia (7%), attack of paroxysmal pain (7%). Most of these complications subsided within 8 weeks. Dysesthesia and hypalgesia that had persisted over 8 weeks were recognized in 30% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Glycerol injection method for trigeminal neuralgia]. 401 Aug 77

Among 23 patients with Sharp's disease, 14 initially had only polyarthritis, Raynaud's syndrome and anti-ribonucleoprotein antibodies. During a mean 5.6 years (range: 1-7 years) follow-up these 14 patients, 2 cases of pericarditis, 1 case of trigeminal neuralgia, 2 cases of nephropathy and 1 case of pulmonary arterial hypertension were observed. The 9 remaining patients had symptoms of multiple collagen disease. They were followed up for a mean of 4.3 years (range: 3-7 years) and 3 developed pericarditis. We discuss the prognostic significance of anti-DNA antibodies (7 cases) and low serum complement (3 cases) which, when combined, seem to be associated with severe visceral lesions.
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PMID:[Evolutive aspects of Sharp's mixed connective tissue disease. 23 cases (author's transl)]. 697 52

Present views on the cause and treatment of temporal arteritis, trigeminal neuralgia, pain arising from the neck, benign intracranial hypertension, and other headaches of intracranial origin are summarized. The clinical components of migraine are correlated with recent studies of cerebral blood flow, monoamine changes, and the platelet release reaction. Psychological, physiological, and pharmacological management is based on the holistic concept of migraine as an uninhibited protective reaction. Cluster headache is subdivided into three varieties which respond preferentially to different medication. Tension headache may depend more on vascular mechanisms than excessive muscle contraction, but treatment is still directed at behavioral management and relaxation training with the aid of antidepressant therapy.
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PMID:Headache. 702 51

Six patients for whom computed tomography revealed a curvilinear calcific mass anterior to their brainstem were evaluated and magnetic resonance imaging and magnetic resonance angiography were performed on each. Magnetic resonance studies confirmed the suspicion of basilar artery dolichoectasia, and demonstrated a partial thrombus in the basilar artery in 1 patient. The patients' clinical features were combined with those of basilar artery dolichoectasia patients reported in the literature (n = 122) who had case histories sufficiently detailed enough to determine each person's mode of clinical presentation. Basilar artery dolichoectasia patients were more often men (95/128, 74%) and had a mean age of 59 +/- 11 years. Of the 128 patients studied, there were cranial nerve compressive signs in 74 (58%), especially facial spasm (29/74, 39%) and trigeminal neuralgia (20/74, 27%); vertebral basilar insufficiency or vertebral basilar stroke or both in 61 (48%); hydrocephalus in 40 (31%); compressive brainstem symptoms and signs that progressed clinically in 31 (24%); and arterial hypertension in 31 (24%). Magnetic resonance imaging and magnetic resonance angiography safely diagnose this interesting arterial abnormality. The modes of clinical presentation of this disorder are reviewed.
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PMID:Basilar artery dolichoectasia. Review of the literature and six patients studied with magnetic resonance angiography. 762 24

The case is reported of a 60-year-old woman with left-sided trigeminal neuralgia, hemifacial spasm, and hypertension. Compression of the left trigeminal, facial, and vagus nerves by the anterior and posterior inferior cerebellar arteries and a persistent trigeminal artery variant were demonstrated by magnetic resonance angiography using a novel sequence. At operation the angiographic appearances were confirmed, and decompression was performed with the placement of polyvinyl sponge at all three levels. Postoperatively, the patient had complete relief from the trigeminal neuralgia and hemifacial spasm and has sustained normotension without medication.
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PMID:Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression. Case report. 811 72

We clinicopathoradiologically assessed 15 angiographically diagnosed megadolichobasilar anomalies. Nine of the patients were male and 6 were female; their average age was 61 years. Eleven patients presented with cerebral ischemic attacks, other two complained of trigeminal neuralgia and the remaining two suffered severe headaches. Twelve of the patients had severe hypertension. Vertebral angiography revealed marked elongation of the basilar artery with severe tortuousity and dilatation. The average distance from the dorsum sellae to the basilar artery bifurcation on the lateral view was 24.7 mm, and the average maximum diameter of the basilar artery was 8.6 mm. Aneurysmal dilatation of the basilar artery was also observed in four cases. In 14 of the 15 patients CT scans revealed characteristic findings, such as tubular high density mass with evident contrast enhancement extending from the ventral medulla to the interpeduncular cistern. The outcome was extremely poor, with five deaths and four patients with severe dementia. In the two autopsy cases, enlarged internal lumens could be observed despite severe atheroscrelotic changes, such as intimal thickening by atheromas.
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PMID:[Clinicopathoradiological studies in 15 cases of megadolichobasilar anomaly]. 819 41

Temporal arteritis is an insidious disease which, if not recognized and treated with high-dosage oral prednisone or intravenous prednisolone, can result in unilateral or even total blindness due to anterior ischemic optic neuropathy (AION) or closure of the central artery of the retina. Unfortunately, the symptoms and clinical signs of temporal arteritis mimic those of a number of other conditions including angle-closure glaucoma, hypertension, migraine, trigeminal neuralgia, temporomandibular joint syndrome, carotid artery occlusive disease, Foster-Kennedy syndrome, and nonarteritic AION. When a patient complains of a severe pain in the temporal region, along with scalp tenderness and a feeling of malaise or depression--with or without episodes of transient loss of vision--he or she should be referred for a diagnostic work-up which includes an erythrocyte sedimentation rate and a temporal artery biopsy. We present here a review of the recent literature concerning temporal arteritis, followed by a report of an unusual case in which high-dosage prednisone therapy was effective in relieving the patient's symptoms and lowering the sedimentation rate in spite of a negative temporal artery biopsy.
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PMID:Diagnosis and management of temporal arteritis: a review and case report. 823 73


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