V Vadokas1, K U Lotzmann. 1. Neurochirugische Klinik und Poliklinik, Georg-August-Universität, Robert-Koch-Straße 40, D-37075, Göttingen.
Abstract
INTRODUCTION: Unfortunately, sharp, severe pain in the area of distribution of the fifth cranial nerve is frequently termed trigeminal neuralgia, and no differentiation is made between typical and atypical neuralgia and other types of facial pain disorders. This can lead to inadequate treatment. CLINICAL MATERIAL AND METHODS: From 1987 to 1993, 577 patients were referred to our clinic with the diagnosis "idiopathic trigeminal neuralgia". Re-examination of these patients was based on a comprehensive history, behavioural and psychosocial assessment, general inspection of the head and neck, evaluation of the craniomandibular system and cervical spine, neurovascular, neurosensory and motor evaluation of cranial nerves, intraoral evaluation, head and cervical spine scans (CT and/or MRI), diagnostic anaesthetic injections, laboratory tests and/or response to therapy. RESULTS: The follow-up examinations and treatment results allowed confirmation of the diagnosis in only 55% of all cases. There were 82 patients (14%) with craniomandibular disorders, 54 patients (9%) with cervical spine syndrome and 18 patients (3%) with cervical and/or dental causality in addition to the trigeminal neuralgia. CONCLUSION: The process of differential diagnosis is critical in trigeminal neuralgia, because an incorrent or missed diagnosis is one of the most frequent causes of treatment failure. As idiopathic trigeminal neuralgia, craniomandibular disorders or the cervical spine syndrome can involve similar symptoms and response to the use of medication, close interdisciplinary cooperation in the process of diagnosis is recommended.
INTRODUCTION: Unfortunately, sharp, severe pain in the area of distribution of the fifth cranial nerve is frequently termed trigeminal neuralgia, and no differentiation is made between typical and atypical neuralgia and other types of facial pain disorders. This can lead to inadequate treatment. CLINICAL MATERIAL AND METHODS: From 1987 to 1993, 577 patients were referred to our clinic with the diagnosis "idiopathic trigeminal neuralgia". Re-examination of these patients was based on a comprehensive history, behavioural and psychosocial assessment, general inspection of the head and neck, evaluation of the craniomandibular system and cervical spine, neurovascular, neurosensory and motor evaluation of cranial nerves, intraoral evaluation, head and cervical spine scans (CT and/or MRI), diagnostic anaesthetic injections, laboratory tests and/or response to therapy. RESULTS: The follow-up examinations and treatment results allowed confirmation of the diagnosis in only 55% of all cases. There were 82 patients (14%) with craniomandibular disorders, 54 patients (9%) with cervical spine syndrome and 18 patients (3%) with cervical and/or dental causality in addition to the trigeminal neuralgia. CONCLUSION: The process of differential diagnosis is critical in trigeminal neuralgia, because an incorrent or missed diagnosis is one of the most frequent causes of treatment failure. As idiopathic trigeminal neuralgia, craniomandibular disorders or the cervical spine syndrome can involve similar symptoms and response to the use of medication, close interdisciplinary cooperation in the process of diagnosis is recommended.