Trigeminal neuralgia causes: Difference between revisions
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== Classification == | == Classification == | ||
According to International Headache Society(IHS), in the International Classification of Headache Disorders, Third Edition (ICHD-3),TN is divided into classic (or classical) TN, secondary TN, and idiopathic TN. | According to International Headache Society(IHS), in the International Classification of Headache Disorders, Third Edition (ICHD-3),TN is divided into classic (or classical) TN, secondary TN, and idiopathic TN.<ref name="pmid29368949">{{cite journal |vauthors= |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |date=January 2018 |pmid=29368949 |doi=10.1177/0333102417738202 |url=}}</ref> | ||
=== Classic trigeminal neuralgia: === | === Classic trigeminal neuralgia: === | ||
Trigeminal neuralgia developing without apparent cause other than neurovascular compression. MRI can demonstrate nerve root atrophy and/or displacement due to neurovascular compression as shown in [[Neurovascular compression of the trigeminal root.jpeg|image]]. | Trigeminal neuralgia developing without apparent cause other than neurovascular compression.<ref name="pmid29368949">{{cite journal |vauthors= |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |date=January 2018 |pmid=29368949 |doi=10.1177/0333102417738202 |url=}}</ref> The common site of neurovascular compression is at the root entry zone, with compression by an artery more clearly associated with symptoms than compression by a vein. The artery involves is mainly superior cerebellar artery in classic TN and the atrophic changes may include demyelination, neuronal loss, changes in microvasculature and other morphological changes.<ref name="url13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition">{{cite web |url=https://www.ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/13-1-1-classical-trigeminal-neuralgia/13-1-1-1-classical-trigeminal-neuralgia-purely-paroxysmal/ |title=13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition |format= |work= |accessdate=}}</ref> MRI can demonstrate nerve root atrophy and/or displacement due to neurovascular compression as shown in [[media:Neurovascular compression of the trigeminal root.jpeg|image]].<ref name="CruccuFinnerup2016">{{cite journal|last1=Cruccu|first1=Giorgio|last2=Finnerup|first2=Nanna B.|last3=Jensen|first3=Troels S.|last4=Scholz|first4=Joachim|last5=Sindou|first5=Marc|last6=Svensson|first6=Peter|last7=Treede|first7=Rolf-Detlef|last8=Zakrzewska|first8=Joanna M.|last9=Nurmikko|first9=Turo|title=Trigeminal neuralgia|journal=Neurology|volume=87|issue=2|year=2016|pages=220–228|issn=0028-3878|doi=10.1212/WNL.0000000000002840}}</ref> | ||
Classical trigeminal neuralgia usually appears in the second or third divisions and the pain rarely occurs bilaterally (sequentially rather than concomitantly). It may be preceded by a period of atypical continuous pain termed ''pre-trigeminal neuralgia'' and most patients remain asymptomatic between the paroxysms.<ref name="url13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition">{{cite web |url=https://www.ichd-3.org/13-painful-cranial-neuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/13-1-1-classical-trigeminal-neuralgia/13-1-1-1-classical-trigeminal-neuralgia-purely-paroxysmal/ |title=13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition |format= |work= |accessdate=}}</ref> | |||
=== Secondary trigeminal neuralgia: === | |||
Trigeminal neuralgia caused by an underlying disease other than neuromuscular compression such as multiple sclerosis or a tumor along the trigeminal nerve. | |||
=== Idiopathic Trigeminal neuralgia: === | |||
Trigeminal neuralgia without an identifiable cause is termed as Idiopathic TN. | |||
All these three categories can present with either purely paroxysmal pain or with additional continuous pain. TN with continuous pain, previously known as atypical TN can best be described as: | |||
==== Painful trigeminal neuropathy: ==== | |||
It can be defined as facial pain in the distribution(s) of one or more branches of the trigeminal nerve that is caused by another disorder and is indicative of neural damage. Unlike TN, the pain is predominantly continuous or near continuous, and is described most often as burning or squeezing, or a pins and needles sensation. Brief paroxysms of pain may occur but are not predominant. Examples include:<ref name="pmid29368949">{{cite journal |vauthors= |title=Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition |journal=Cephalalgia |volume=38 |issue=1 |pages=1–211 |date=January 2018 |pmid=29368949 |doi=10.1177/0333102417738202 |url=}}</ref><ref name="CruccuFinnerup2016">{{cite journal|last1=Cruccu|first1=Giorgio|last2=Finnerup|first2=Nanna B.|last3=Jensen|first3=Troels S.|last4=Scholz|first4=Joachim|last5=Sindou|first5=Marc|last6=Svensson|first6=Peter|last7=Treede|first7=Rolf-Detlef|last8=Zakrzewska|first8=Joanna M.|last9=Nurmikko|first9=Turo|title=Trigeminal neuralgia|journal=Neurology|volume=87|issue=2|year=2016|pages=220–228|issn=0028-3878|doi=10.1212/WNL.0000000000002840}}</ref><ref name="urlUpToDate">{{cite web |url=https://www.uptodate.com/contents/trigeminal-neuralgia?search=trigeminal%20neuralgia&source=search_result&selectedTitle=1~77&usage_type=default&display_rank=1#H5 |title=UpToDate |format= |work= |accessdate=}}</ref> | |||
* Painful trigeminal neuropathy attributed to acute [[herpes zoster]] | |||
* Trigeminal postherpetic neuropathy | |||
* Painful post-traumatic trigeminal neuropathy | |||
* Painful trigeminal neuropathy attributed to other disorder | |||
* Idiopathic painful trigeminal neuropathy | |||
==Causes<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>== | ==Causes<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>== | ||
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===Causes in Alphabetical Order=== | ===Causes in Alphabetical Order=== | ||
{{columns-list | {{columns-list| | ||
*[[Abnormal vessels]] | *[[Abnormal vessels]] | ||
*[[Acoustic neuroma]] | *[[Acoustic neuroma]] | ||
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*[[Cluster headache]] | *[[Cluster headache]] | ||
*[[Dental infection]] | *[[Dental infection]] | ||
*[[Diabetes mellitis]] | |||
*[[Epidermoid]] | *[[Epidermoid]] | ||
*[[Facial spasm]] | *[[Facial spasm]] | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
[[File:Neurovascular compression of the trigeminal root.jpeg|thumb|3D constructive interference in steady state MRI shows axial sections at the level of trigeminal nerve root entry into the pons. (A) Bilateral neurovascular contact without morphologic changes of the root in a patient with left trigeminal neuralgia (TN). Nerve (long arrows) and blood vessel (short arrows) appear hypointense surrounded by hyperintense CSF. Contact is seen at the root entry zone as well as mid-cisternal segment. (B, C) Morphologic changes exceeding mere neurovascular contact of the trigeminal nerve root are compatible with the diagnosis of classical TN. (B) Root atrophy in a patient with right TN. (C) Indentation and dislocation of the root in a patient with right TN (short arrow).]] | [[File:Neurovascular compression of the trigeminal root.jpeg|thumb|3D constructive interference in steady state MRI shows axial sections at the level of trigeminal nerve root entry into the pons. (A) Bilateral neurovascular contact without morphologic changes of the root in a patient with left trigeminal neuralgia (TN). Nerve (long arrows) and blood vessel (short arrows) appear hypointense surrounded by hyperintense CSF. Contact is seen at the root entry zone as well as mid-cisternal segment. (B, C) Morphologic changes exceeding mere neurovascular contact of the trigeminal nerve root are compatible with the diagnosis of classical TN. (B) Root atrophy in a patient with right TN. (C) Indentation and dislocation of the root in a patient with right TN (short arrow).]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Neurology]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hardik Patel, M.D. Luke Rusowicz-Orazem, B.S.
Overview
Common causes of trigeminal neuralgia include sources of nerve compression from cardiovascular obstruction, tumor pressure, infectious disease, and facial trauma.
Classification
According to International Headache Society(IHS), in the International Classification of Headache Disorders, Third Edition (ICHD-3),TN is divided into classic (or classical) TN, secondary TN, and idiopathic TN.[1]
Classic trigeminal neuralgia:
Trigeminal neuralgia developing without apparent cause other than neurovascular compression.[1] The common site of neurovascular compression is at the root entry zone, with compression by an artery more clearly associated with symptoms than compression by a vein. The artery involves is mainly superior cerebellar artery in classic TN and the atrophic changes may include demyelination, neuronal loss, changes in microvasculature and other morphological changes.[2] MRI can demonstrate nerve root atrophy and/or displacement due to neurovascular compression as shown in image.[3]
Classical trigeminal neuralgia usually appears in the second or third divisions and the pain rarely occurs bilaterally (sequentially rather than concomitantly). It may be preceded by a period of atypical continuous pain termed pre-trigeminal neuralgia and most patients remain asymptomatic between the paroxysms.[2]
Secondary trigeminal neuralgia:
Trigeminal neuralgia caused by an underlying disease other than neuromuscular compression such as multiple sclerosis or a tumor along the trigeminal nerve.
Idiopathic Trigeminal neuralgia:
Trigeminal neuralgia without an identifiable cause is termed as Idiopathic TN.
All these three categories can present with either purely paroxysmal pain or with additional continuous pain. TN with continuous pain, previously known as atypical TN can best be described as:
Painful trigeminal neuropathy:
It can be defined as facial pain in the distribution(s) of one or more branches of the trigeminal nerve that is caused by another disorder and is indicative of neural damage. Unlike TN, the pain is predominantly continuous or near continuous, and is described most often as burning or squeezing, or a pins and needles sensation. Brief paroxysms of pain may occur but are not predominant. Examples include:[1][3][4]
- Painful trigeminal neuropathy attributed to acute herpes zoster
- Trigeminal postherpetic neuropathy
- Painful post-traumatic trigeminal neuropathy
- Painful trigeminal neuropathy attributed to other disorder
- Idiopathic painful trigeminal neuropathy
Causes[5] [6]
Common Causes
- Acoustic Neuroma
- Blood vessels compressing the trigeminal nerve root
- Brain Tumor
- Chronic meningeal infection
- Cluster headache
- Dental Infection
- Glossopharyngeal neuralgia
- Idiopathic
- Ischemic cerebrovascular disorders
- Multiple Sclerosis
- Physical damage to the nerve
- Postherpetic neuralgia
- Temporomadibular Joint Syndrome
- Vascular malformation
Causes by Organ System
Causes in Alphabetical Order
- Abnormal vessels
- Acoustic neuroma
- Aging
- Aneurysms
- Arterial compression
- Arteriovenous malformation
- Blood vessels compressing the trigeminal nerve root
- Brain tumor
- Chronic meningeal inflammation
- Chronic meningeal infection
- Cluster headache
- Dental infection
- Diabetes mellitis
- Epidermoid
- Facial spasm
- Facial trauma
- Glossopharyngeal neuralgia
- Idiopathic
- Ischemic cerebrovascular disorders
- Lyme disease
- Meningioma
- Multiple sclerosis
- Oral surgery
- Pain syndrome
- Physical damage to the nerve
- Postherpetic neuralgia
- Saccular aneurysm
- Sarcoidosis
- Scleroderma
- Sinus surgery
- Stroke
- Systemic lupus erythematosus
- Temporomadibular joint syndrome
- Tumors
- Vascular anomalies
- Vascular compression
- Vascular malformation
- Vestibular schwannoma
References
- ↑ 1.0 1.1 1.2 "Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition". Cephalalgia. 38 (1): 1–211. January 2018. doi:10.1177/0333102417738202. PMID 29368949.
- ↑ 2.0 2.1 "13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition".
- ↑ 3.0 3.1 Cruccu, Giorgio; Finnerup, Nanna B.; Jensen, Troels S.; Scholz, Joachim; Sindou, Marc; Svensson, Peter; Treede, Rolf-Detlef; Zakrzewska, Joanna M.; Nurmikko, Turo (2016). "Trigeminal neuralgia". Neurology. 87 (2): 220–228. doi:10.1212/WNL.0000000000002840. ISSN 0028-3878.
- ↑ "UpToDate".
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
