Siccoli Massimiliano M, Bassetti Claudio L, Sándor Peter S
Neurology Department, University Hospital, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Lancet Neurol. 2006 Mar;5(3):257-67. doi: 10.1016/S1474-4422(06)70375-1.
Differential diagnosis of pain in the face as the presenting complaint can be difficult. We propose an approach based on history and neurological examination, which allows a working diagnosis to be made at the bedside, including aetiological hypotheses, leading to a choice of investigations. Neuralgias are characterised by stabs of short lasting, lancinating pain, and, although neuralgias are often primary, imaging may be needed to exclude symptomatic forms. Facial pain with cranial nerve symptoms and signs is almost exclusively of secondary origin and requires urgent examination. Facial pain with focal autonomic signs is mostly primary and belongs to the group of the idiopathic trigeminal autonomic cephalalgias, but can occasionally be secondary. Pure facial pain is most often due to sinusitis and the chewing apparatus, but also a multitude of other causes. The pain can also be idiopathic. Imaging as well as non-neurological specialist assessment is often necessary in these cases.
以面部疼痛作为主诉的鉴别诊断可能具有挑战性。我们提出一种基于病史和神经学检查的方法，该方法能够在床边做出初步诊断，包括病因假设，从而指导检查项目的选择。神经痛的特征是短暂、刺痛样的剧痛，虽然神经痛通常为原发性，但可能仍需进行影像学检查以排除症状性类型。伴有脑神经症状和体征的面部疼痛几乎均为继发性，需要紧急检查。伴有局灶性自主神经体征的面部疼痛大多为原发性，属于特发性三叉神经自主神经性头痛组，但偶尔也可能是继发性的。单纯的面部疼痛最常见的原因是鼻窦炎和咀嚼器官问题，但也有许多其他原因。疼痛也可能是特发性的。在这些情况下，影像学检查以及非神经科专科评估通常是必要的。
