Trigeminal neuralgia: case report and literature review

Abstract

Trigeminal neuralgia (TN), also known as tic doloureaux, is a nerve disorder of the face and is considered to be one of the most painful human conditions. A 51-year-old male presented with severe intermittent pain on the left side of his face. Magnetic resonance image scan with contrast revealed a close association of the superior cerebella artery and the trigeminal nerve on the left side of the face. Oral medication is the first line of treatment for TN, because of its non-invasiveness, low cost and high effective rate. Surgical intervention for TN aims to relieve the pressure of the offending artery or vein that is compressing the trigeminal nerve or in other instances; surgery may stop the uncontrolled pain signals. An important criterion for clinical diagnosis is pain that cannot be attributed to another disorder and also the lack of evident neurologic disorder. TN is one of the most debilitating diseases an individual may suffer and an early astute diagnosis of TN will provide patients with relief from suffering, unnecessary dental and medical intervention. Appropriate and early diagnosis of TN is important to formulate an optimal management plan based on the patient's age and general condition. The aim of this case report is to describe a case of Classical TN, and subsequent successful surgical management with microvascular decompression.

Trigeminal Neuralgia: Etiology, Diagnosis, and Treatment

“…Classical TN results from a neurovascular conflict that causes compression on the trigeminal nerve 12 . This classification can be further subdivided into classical TN that is purely paroxysmal where the patient has no pain between attacks or classical TN with concomitant continuous pain in which that patient experiences persistent background facial pain between the attacks 2,15 . The latter was previously described as type 2 TN or atypical TN in the literature as it has shown to be resistant to several of the current treatment modalities 15 .…”

“…This classification of TN is occasionally referred in the literature as secondary TN because it is caused by an underlying pathology, and TN is occurring secondary to the condition [15]. Symptomatic TN is therefore the consequence of major neurologic disease such as a space-occupying tumor or lesion at the cerebellopontine angle, multiple sclerosis, herpes zoster virus, or even trauma [2].…”

“…Clinically, patients with TN describe a sudden shooting or stabbing pain that can present as solitary sensations or as paroxysms that are limited to the distribution of the trigeminal nerve [15]. TN manifests with one or several symptoms including intense, shooting, and stabbing pain that is often compared with electric shocks; however, it can also present as intermittent periods of mild pain, spasms of pain, or episodes of cluster attacks [2]. The onset of TN is usually memorable for the patients, and they can usually describe their first attack.…”

“…Attacks of pain are usually abrupt and last several seconds although they can persist for 1 to 2 min [14]. Over time, the pain attacks usually become more frequent and increase in severity [2]. Furthermore, there can be a "refractory period" where despite further stimulation the pain cannot be provoked [25].…”

“…Trigeminal neuralgia (TN), also known as "tic douloureux," is an extremely painful nerve disorder that is often difficult to diagnose [1]. It has been characterized as one of the most physically and psychologically painful conditions that one can potentially suffer from [2]. In addition, it is known to be the most common and most serious of the facial neuralgias [3].…”