Trigeminal Neuralgia
(TN)
Background
tic douloureux (痛性抽搐)
neurologic examination findings are normal
unilateral pain following the sensory distribution of cranial nerve V
maxillary (V2) or mandibular (V3) area in 35% of affected patients
ophthalmic division much mon (%)
Anatomy
The ophthalmic division exits the cranium via the superior orbital fissure;(眶上裂)
The maxillary divisions exit via the foramen rotundum;(圆孔)
The mandibular divisions exit via foramen ovale;(卵圆孔)
Signs and symptoms
Triggers of pain attacks include the following:
Chewing, talking, or smiling
Drinking cold or hot fluids
Touching, shaving, brushing teeth, blowing the nose
Encountering cold air from an open automobile window
Pain localization is as follows:
Patients can localize their pain precisely
The monly runs along the line dividing either the mandibular and maxillary nerves or the mandibular and ophthalmic portions of the nerve
In 60% of cases, the pain shoots from the corner of the mouth to the angle of the jaw(下颌角)
In 30%, pain jolts from the upper lip or canine teeth to the eye and eyebrow, sparing the orbit itself
In less than 5% of cases, pain involves the ophthalmic branch of the facial nerve
The pain has the following qualities:
Characteristically severe, paroxysmal,(阵发的) and lancinating(刺痛)
Commences with a sensation of electrical shocks in the affected area
Crescendos in less than 20 seconds to an excruciating fort felt deep in the face, often contorting the patient's expression
Begins to fade within seconds, only to give way to a burning ache lasting seconds to minutes
Pain fully abates between attacks, even when they are severe and frequent
Attacks may provoke patients to grimace, wince, or make an aversive head movement, as if trying to escape the pain, thus producing an obvious movement, or tic; hence the term "tic douloureux"
Other diagnostic clues are as follows:
Patients carefully avoid rubbing the face or shaving a trigger area, in contr
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