Trigeminal neuralgia causes

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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

Causes by Organ System

Cardiovascular Abnormal vessels, Arterial compression, Arteriovenous malformation, Ischemic cerebrovascular disorders, Stroke, Vascular anomalies, Vascular compression, Vascular malformation
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Epidermoid, Scleroderma
Drug Side Effect No underlying causes
Ear Nose Throat Glossopharyngeal neuralgia, Oral surgery, Sinus surgery, Temporomadibular joint syndrome
Endocrine Diabetes mellitis
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Aneurysms, Blood vessels compressing the trigeminal nerve root, Saccular aneurysm
Iatrogenic Sinus surgery
Infectious Disease Chronic meningeal inflammation, Chronic meningeal infection, Dental infection, Lyme disease, Postherpetic neuralgia
Musculoskeletal/Orthopedic Facial spasm, Temporomadibular joint syndrome
Neurologic Acoustic neuroma, Blood vessels compressing the trigeminal nerve root, Brain tumor, Chronic meningeal inflammation, Chronic meningeal infection, Cluster headache, Epidermoid, Facial spasm, Glossopharyngeal neuralgia, Ischemic cerebrovascular disorders, Meningioma, Multiple sclerosis, Pain syndrome, Physical damage to the nerve, Postherpetic neuralgia, Saccular aneurysm, Vascular anomalies, Vascular compression, Vestibular schwannoma
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Brain tumor, Meningioma, Tumors, Vestibular schwannoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Sarcoidosis, Systemic lupus erythematosus
Sexual No underlying causes
Trauma Facial trauma, Physical damage to the nerve
Urologic No underlying causes
Miscellaneous Aging, Idiopathic

Causes in Alphabetical Order

References

  1. 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. 2.0 2.1 "13.1.1.1 Classical trigeminal neuralgia - ICHD-3 The International Classification of Headache Disorders 3rd edition".
  3. 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.
  4. "UpToDate".
  5. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  6. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
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).



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