Trigeminal neuralgia differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Trigeminal_neuralgia]] | |||
== | == Overview: == | ||
The differential diagnosis of TN includes the conditions that cause classic TN and secondary TN, mainly compression of the trigeminal nerve by a vascular loop or a nonvascular space-occupying lesion, and demyelination from [[multiple sclerosis]] in the pons or root entry zone of the trigeminal nerve. Although less likely to be confused with TN, the differential diagnosis also includes various causes of painful trigeminal neuropathy, such as acute [[herpes zoster]], [[postherpetic neuralgia]], and [[Physical trauma|trauma]] to the trigeminal nerve. In most cases, painful trigeminal neuropathy can be distinguished from TN by a thorough history and examination.<ref name="urlUpToDate">{{cite web |url=https://www.uptodate.com/contents/trigeminal-neuralgia?search=trigeminal%20neuralgia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H11 |title=UpToDate |format= |work= |accessdate=}}</ref> A history of persistent pain or [[pain]] that occurs episodically in attacks lasting longer than two minutes eliminates classical trigeminal neuralgia and should lead to a search for other diagnoses. The pain of [[glossopharyngeal neuralgia]], which may be triggered by talking or swallowing, is located in the tongue and pharynx.<ref>RUDOLPH M. KRAFFT, MD, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio | |||
The differential diagnosis of TN includes the conditions that cause classic TN and secondary TN, mainly compression of the trigeminal nerve by a vascular loop or a nonvascular space-occupying lesion, and demyelination from multiple sclerosis in the pons or root entry zone of the trigeminal nerve. Although less likely to be confused with TN, the differential diagnosis also includes various causes of painful trigeminal neuropathy, such as acute herpes zoster, postherpetic neuralgia, and trauma to the trigeminal nerve. In most cases, painful trigeminal neuropathy can be distinguished from TN by a thorough history and examination. A history of persistent pain or pain that occurs episodically in attacks lasting longer than two minutes eliminates classical trigeminal neuralgia and should lead to a search for other diagnoses. The pain of glossopharyngeal neuralgia, which may be triggered by talking or swallowing, is located in the tongue and pharynx. Some differentials are listed in the table below: | Am Fam Physician. 2008 May 1;77(9):1291-1296</ref>. Some differentials are listed in the table below: | ||
== '''Differential diagnosis of trigeminal neuralgia''' == | == '''Differential diagnosis of trigeminal neuralgia''' == | ||
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! | ! | ||
|- | |- | ||
|Diagnosis | | | ||
|Differentiating features | === Diagnosis === | ||
| | |||
=== Differentiating features === | |||
|- | |- | ||
|Glossopharyngeal neuralgia | |[[Glossopharyngeal neuralgia]] | ||
|Pain in tongue, mouth, or throat; brought on by swallowing, talking, or chewing | |Pain in tongue, mouth, or throat; brought on by swallowing, talking, or chewing | ||
|- | |- | ||
|Cluster headache | |[[Cluster headache]] | ||
|Longer-lasting pain; orbital or supraorbital; may cause patient to wake from sleep; autonomic symptoms | |Longer-lasting pain; [[Orbital Disease|orbital]] or [[supraorbital]]; may cause patient to wake from sleep; autonomic symptoms | ||
|- | |- | ||
|Cluster tic syndrome | |Cluster tic syndrome | ||
| Line 26: | Line 28: | ||
|Transient; sharp jabbing pains; variable locations within trigeminal and cervical dermatomes | |Transient; sharp jabbing pains; variable locations within trigeminal and cervical dermatomes | ||
|- | |- | ||
|Dental pain (e.g., caries, cracked tooth, pulpitis) | |[[Toothache|Dental pain]] (e.g., [[caries]], cracked tooth, [[pulpitis]]) | ||
|Localized; related to biting or hot or cold foods; visible abnormalities on oral examination | |Localized; related to biting or hot or cold foods; visible abnormalities on oral examination | ||
|- | |- | ||
|Migraine | |[[Migraine]] | ||
|Longer-lasting pain; associated with photophobia and phonophobia; family history | |Longer-lasting pain; associated with [[photophobia]] and [[phonophobia]]; family history | ||
|- | |- | ||
|Giant cell arteritis | |[[Giant cell arteritis]] | ||
|Persistent pain; temporal; often bilateral; jaw claudication | |Persistent pain; [[temporal]]; often bilateral; [[jaw claudication]] | ||
|- | |- | ||
|Otitis media | |[[Otitis media]] | ||
|Pain localized to ear; abnormalities on examination and tympanogram | |Pain localized to ear; abnormalities on examination and [[tympanogram]] | ||
|- | |- | ||
|Paroxysmal hemicrania | |[[Chronic paroxysmal hemicrania|Paroxysmal hemicrania]] | ||
|Pain in forehead or eye; autonomic symptoms; lasts only seconds; do not respond to carbamazepine | |Pain in forehead or eye; autonomic symptoms; lasts only seconds; do not respond to [[carbamazepine]] | ||
|- | |- | ||
|Sinusitis | |[[Sinusitis]] | ||
|Persistent pain; associated nasal symptoms | |Persistent pain; associated nasal symptoms | ||
|- | |- | ||
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|Persistent pain; localized tenderness; jaw abnormalities | |Persistent pain; localized tenderness; jaw abnormalities | ||
|- | |- | ||
|Post herpetic neuralgia | |[[Postherpetic neuralgia|Post herpetic neuralgia]] | ||
|Continuous pain; tingling; history of zoster; often first division | |Continuous pain; tingling; history of zoster; often first division | ||
|- | |- | ||
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|- | |- | ||
|SUNCT/SUNA | |SUNCT/SUNA | ||
|Severe unilateral head pain in orbital, periorbital, or temporal regions; ipsilateral autonomic symptoms | |Severe unilateral head pain in [[Orbit (anatomy)|orbital]], periorbital, or [[temporal]] regions; [[ipsilateral]] autonomic symptoms | ||
|} | |} | ||
SUNCT: short lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing | SUNCT: short lasting, unilateral, neuralgiform headache attacks with [[conjunctival injection]] and tearing | ||
SUNA: short lasting, unilateral, neuralgiform headache attacks with autonomic symptoms | SUNA: short lasting, unilateral, neuralgiform headache attacks with autonomic symptoms | ||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
[[Category:Pain]] | [[Category:Pain]] | ||
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[[Category:Rare diseases]] | [[Category:Rare diseases]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Latest revision as of 00:30, 30 July 2020
Overview:
The differential diagnosis of TN includes the conditions that cause classic TN and secondary TN, mainly compression of the trigeminal nerve by a vascular loop or a nonvascular space-occupying lesion, and demyelination from multiple sclerosis in the pons or root entry zone of the trigeminal nerve. Although less likely to be confused with TN, the differential diagnosis also includes various causes of painful trigeminal neuropathy, such as acute herpes zoster, postherpetic neuralgia, and trauma to the trigeminal nerve. In most cases, painful trigeminal neuropathy can be distinguished from TN by a thorough history and examination.[1] A history of persistent pain or pain that occurs episodically in attacks lasting longer than two minutes eliminates classical trigeminal neuralgia and should lead to a search for other diagnoses. The pain of glossopharyngeal neuralgia, which may be triggered by talking or swallowing, is located in the tongue and pharynx.[2]. Some differentials are listed in the table below:
Differential diagnosis of trigeminal neuralgia
Diagnosis |
Differentiating features |
| Glossopharyngeal neuralgia | Pain in tongue, mouth, or throat; brought on by swallowing, talking, or chewing |
| Cluster headache | Longer-lasting pain; orbital or supraorbital; may cause patient to wake from sleep; autonomic symptoms |
| Cluster tic syndrome | Cluster headache with coexistent trigeminal neuralgia |
| Primary stabbing headache | Transient; sharp jabbing pains; variable locations within trigeminal and cervical dermatomes |
| Dental pain (e.g., caries, cracked tooth, pulpitis) | Localized; related to biting or hot or cold foods; visible abnormalities on oral examination |
| Migraine | Longer-lasting pain; associated with photophobia and phonophobia; family history |
| Giant cell arteritis | Persistent pain; temporal; often bilateral; jaw claudication |
| Otitis media | Pain localized to ear; abnormalities on examination and tympanogram |
| Paroxysmal hemicrania | Pain in forehead or eye; autonomic symptoms; lasts only seconds; do not respond to carbamazepine |
| Sinusitis | Persistent pain; associated nasal symptoms |
| Temporomandibularjoint syndrome | Persistent pain; localized tenderness; jaw abnormalities |
| Post herpetic neuralgia | Continuous pain; tingling; history of zoster; often first division |
| Trigeminal neuropathy | Persistent pain; associated sensory loss |
| SUNCT/SUNA | Severe unilateral head pain in orbital, periorbital, or temporal regions; ipsilateral autonomic symptoms |
SUNCT: short lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing
SUNA: short lasting, unilateral, neuralgiform headache attacks with autonomic symptoms
References
- ↑ "UpToDate".
- ↑ RUDOLPH M. KRAFFT, MD, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio Am Fam Physician. 2008 May 1;77(9):1291-1296