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[颅面神经痛]

[Craniofacial neuralgias].

作者信息

Mikula Ivan

机构信息

Klinika za neurologiju, Referentni centar za neurovaskularne poremećaje Ministarstva zdravstva RH, Klinicka bolnica Sestre milosrdnice, Zagreb, Hrvatska.

出版信息

Acta Med Croatica. 2008 May;62(2):163-72.

Abstract

Craniofacial neuralgias are characterized by sudden paroxysmal pain along the distribution of one or more of the cranial or upper cervical spinal nerves. The most significant neuralgia of the craniofacial region is trigeminal neuralgia, while geniculate neuralgia, glossopharyngeal neuralgia and occipital neuralgia are less common. Trigeminal neuralgia may be primary or secondary. Idiopathic trigeminal neuralgia or tic douloureux has been recognized for centuries as an extremely painful disorder most commonly involving the maxillary nerve. Recurrent lancinating, shocklike unilateral pain lasting for seconds to minutes is provoked by non noxious stimulation of the skin at specific sites around the face and less frequently by movement of the tongue. The trigger zones are usually within the same dermatome as the painful sensation. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce pain. Idiopathic trigeminal neuralgia occurs somewhat more frequently in women and usually begins in individuals 50 to 70 years of age. There is no pain between attacks, and the frequency of painful episodes can range from several per day to only a few per year. With time, the features may become more atypical, with greater areas of more enduring and dull pain and occasionally bilateral pain, rarely on both sides simultaneously. No sensory or reflex deficit is detectable by routine neurologic testing. Diagnostic local anesthetic blocks will identify the specific nerves involved and the trigger point distribution. Neurologic and neuroradiologic examination is advised in all cases to rule out diseases such as intracranical tumors, vascular malformations or multiple sclerosis.

摘要

颅面部神经痛的特点是沿一条或多条颅神经或颈上脊髓神经分布区域出现突发的阵发性疼痛。颅面部最常见的神经痛是三叉神经痛,而膝状神经节神经痛、舌咽神经痛和枕神经痛则较少见。三叉神经痛可分为原发性或继发性。特发性三叉神经痛或痛性抽搐几个世纪以来一直被认为是一种极其疼痛的疾病,最常累及上颌神经。面部特定部位皮肤受到非伤害性刺激,较少情况下因舌头运动,可引发反复发作的、呈闪电样的单侧疼痛,持续数秒至数分钟。触发区通常与疼痛感觉在同一皮节内。每次发作后,通常有一个不应期,在此期间刺激触发区不会诱发疼痛。特发性三叉神经痛在女性中更为常见,通常始于50至70岁的人群。发作间期无疼痛,疼痛发作频率从每天数次到每年仅几次不等。随着时间推移,症状可能变得更不典型,出现更大面积的更持久的钝痛,偶尔出现双侧疼痛,很少双侧同时出现。常规神经学检查未发现感觉或反射缺陷。诊断性局部麻醉阻滞可确定受累的具体神经和触发点分布。建议对所有病例进行神经学和神经放射学检查,以排除颅内肿瘤、血管畸形或多发性硬化等疾病。

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