Anesthesia Dolorosa Caused by Penetrating Cranial Injury

Abstract

Anesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia. Its incidence is around 0.8%. To our best knowledge, AD caused by a penetrating cranial injury has not been reported previously. We report the case of a 31-year-old male patient with left-sided neuropathic keratitis and AD that began 18 years earlier, following a penetrating cranial injury with a knife to the left postauricular area. The patient was successfully treated by a carbamazepine and gabapentin combination. In conclusion, penetrating cranial injury is uncommon but may cause a serious neurologic disturbance. In the differential diagnosis of AD, a penetrating injury should be kept in mind. In these cases, treatments should be effective and immediate; otherwise, this may result in catastrophic consequences such as neurotrophic keratitis and blindness. Ophthalmologists should be aware of these potential problems.

Pathology of the Trigeminal Nerve

“…A light touch or vibration is the most effective trigger. [10][11][12][13][14][15][16][17] Because of this, common daily activities, such as brushing the teeth, shaving, eating, drinking, or talking, trigger the attacks. Typically, attacks are similar in individual patients and no neurologic deficits are clinically evident.…”