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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of hysterical conversion, which was initially diagnosed as trigeminal neuralgia. The pain in the face and head which the patient complained seemed to be consistent with symptoms of trigeminal neuralgia. But it could not be relieved by repeated peripheral nerve blocks and even by Gasserian blocks. Failure to relieve pain by such blocks and concomitant hemifacial spasm with closure of the eye appeared to afford indication of microvascular decompression surgery. Injection of edrophonium before operation, for the purpose of differential diagnosis of myasthenic ptosis, made the patient free from all symptoms, i.e. facial pain, spasm, and ptosis. The diagnosis of hysterical conversion was made on this irrational episode. When we looked back the total clinical course, it was revealed that the patient's complaints and symptoms had been rather atypical, too various, and not anatomical. We also confirmed that various other episodes of this patient which had not received our attention during treatment were psychological features of hysteria, but we could not make his psychological stress clear, which had been in the background of hysterical conversion.
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PMID:[A case of hysterical conversion manifested by pain in face and head]. 202 Jan 7

Total sensory loss, ptosis, ocular muscle palsy and pupil dilatation were noted after alcohol injection into mandibular nerve for idiopathic trigeminal neuralgia (in the right 2. and 3. division). The diagnosis was made that the injected alcohol induced the Gasserian palsy and oculomotor palsy. The oculomotor palsy was fully recovered except slight pupil dilatation after four months. The mechanism and prophylaxis of these complications are discussed.
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PMID:[Complications of alcohol injection into the mandibular nerve. Gasserian palsy and oculomotor palsy (author's transl)]. 697 62

Two patients suffering from SUNCT syndrome are presented. Some features are remarkable. The first patient was a 69-year-old man whose first crisis was located in the right supraorbital region. After a 4-month spontaneous remission, the pain returned to the upper part of the cheek, radiating to the supraciliary region on the same side, with lacrimation and conjunctival injection. Rhinorrhea was absent. The painful attacks were triggered by head movements. Clinical improvement occurred with carbamazepine treatment. The second patient was a 48-year-old woman whose painful attacks lasted from 30 to 45 seconds followed by a burning sensation lasting 2 hours. Autonomic signs such as conjunctival injection, lacrimation, and edema and ipsilateral ptosis of the upper lid were rather marked. There was never any rhinorrhea. Her attacks were triggered by head and eye movements. She responded to the administration of corticosteroids and carbamazepine. According to these features, the two patients had SUNCT syndrome, and the positive carbamazepine response suggests a relationship with trigeminal neuralgia.
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PMID:SUNCT syndrome. Two cases in Argentina. 963 Jul 90

The syndrome of short-lasting unilateral, neuralgiform attacks of pain in the peri orbital area associated with conjunctival injection and tearing (SUNCT) is a rare disorder affecting mainly males. We report two French patients (1 male and 1 female) with SUNCT syndrome, 27 and 28 years of age respectively. Both patients had short (30 sec), frequent (30-100/day) excruciating pain located at the peri orbital area, associated with conjunctival injection, tearing, rhinorrhea, ptosis and others vasomotor symptoms. Clinical examination and imaging were normal. Most drugs used in the treatment of migraine, cluster headache, trigeminal neuralgia, and other short-lasting headaches were not successful.
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PMID:[Idiopathic SUNCT (short lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea) syndrome: 2 new cases]. 1192 48

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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PMID:Objective assessment of autonomic signs during triggered first division trigeminal neuralgia. 1210 85

Idiopathic trigeminal neuralgia is almost always associated with pathological nerve/vessel contact. Symptomatic forms of trigeminal neuralgia include cases of multiple sclerosis, infratentorial tumours and postherpetic neuralgia. Vascular malformations causing neuralgia have rarely been reported. We present the case of a 55-year old woman, who suffered from facial pain and ptosis on her left side. Repeated neurological examinations as well as repeated magnetic resonance imaging did not lead to a definite diagnosis or therapy. The pain suddenly stopped three weeks before admission and only a slight left sided facial hypaesthesia persisted. Reevaluating the older MRI we found a small signal alteration of 2 mm in the caudal part of the left trigeminal nucleus. A new MRI showed a subacute haemorrhage into a small brainstem cavernoma, which must have caused the pain and later on the hypaesthesia. Small vascular malformations are a rare cause of neuropathic facial pain.
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PMID:[Chronic facial pain due to a brainstem cavernoma]. 1764 50

Posterior cranial fossa tumours, not involving the cerebellopontine angle cistern, are a rare cause of trigeminal neuralgia (TN). We describe a patient with a large paramedian tentorial meningioma associated with acquired Chiari malformation who presented with TN. Trigeminal pain resolved after gross total tumour resection and postoperative magnetic resonance images disclosed a minimal residual tumour in the torcular region as well as ascent of cerebellar tonsils. In this article, we investigate the physiopathological hypotheses for this unusual association with emphasis on the role of tonsillar prolapse as neuropathological basis of neuropathic pain in this patient.
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PMID:Trigeminal neuralgia as initial symptom of paramedian tentorial meningioma. 1916 26

A 45-year-old female developed mild dysesthesia and swelling, followed by ptosisand trigeminal pain, in the right side of the face. Her past medical history was unremarkable, and she had not been aware of any infectious sign. A local otolaryngologist administered glucocorticoid therapy that resolved the face pain, but the ptosis persisted. Neurological examination found complete right oculomotor nerve paresis and mild sensory loss in the first and second segments of the right trigeminal nerve. Blood examination found no abnormalities. Neuroimaging revealed a saccular aneurysm at the branching site of the posterior communicating artery, projecting posteriorly and adjacent to the dorsum sellae, without other intracranial abnormalities. Cerebral angiography demonstrated poor opacification of the superior ophthalmic vein and cavernous sinus on the right side. The patient underwent coil embolization under a diagnosis of symptomatic aneurysm, but her oculomotor neuropathy was only partially improved. We thought that the impairment of the oculomotor function by inflammatory reaction in the cavernous sinus and mechanical compression by the aneurysm had already persisted for too long for post-treatment recovery. We think that the simultaneous occurrence of Tolosa-Hunt syndrome and oculomotor nerve palsy may have resulted because trigeminal neuralgia had increased the blood pressure to induce rapid growth of the preexisting aneurysm, or the inflammatory reaction in the cavernous sinus had promoted the growth of the aneurysm, or that the association was by chance.
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PMID:[Simultaneous presentation of Tolosa-Hunt syndrome and oculomotor nerve palsy due to the nonruptured internal carotid-posterior communicating artery aneurysm: a case report]. 1936 32

We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.
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PMID:[A case of cavernous sinus aspergillosis]. 2409 62

The cranial synkineses are a group of disorders encompassing a variety of involuntary co-contractions of the facial, masticatory, or extraocular muscles that occur during a particular volitional movement. The neuroanatomical pathways for synkineses largely remain undefined. Our studies explored a normal synkinesis long observed in the general population - that of jaw opening during efforts to open the eyelids widely. To document this phenomenon, we observed 186 consecutive participants inserting or removing contact lenses to identify jaw opening. Seeking electrophysiological evidence, in a second study we enrolled individuals undergoing vascular decompression for trigeminal neuralgia or hemifacial spasm, without a history of jaw-winking, ptosis, or strabismus, to record any motor responses in levator palpebrae superioris (LPS) upon stimulation of the trigeminal motor root. Stimulus was applied to the trigeminal motor root while an electrode in levator recorded the response. We found that 37 participants (20%) opened their mouth partially or fully during contact lens manipulation. In the second study, contraction of LPS with trigeminal motor stimulation was documented in two of six patients, both undergoing surgery for trigeminal neuralgia. We speculate these results might provide evidence of an endogenous synkinesis, indicating that trigeminal-derived innervation of levator could exist in a significant minority of the general population. Our observations demonstrate plasticity in the human cranial nerve innervation pattern and may have implications for treating Marcus Gunn jaw-winking.
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PMID:Evidence of ancillary trigeminal innervation of levator palpebrae in the general population. 2412 Jul 6


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