scholarly journals Postherpetic Neuralgia and Trigeminal Neuralgia

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
L. Feller ◽  
R. A. G. Khammissa ◽  
J. Fourie ◽  
M. Bouckaert ◽  
J. Lemmer

Postherpetic neuralgia (PHN) is an unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons and which can induce psychosocial dysfunction and can negatively impact on quality of life. Preventive options for PHN include vaccination of high-risk persons against HZ, early use of antiviral agents, and robust management of pain during the early stage of acute herpes zoster. If it does occur, PHN may persist for months or even years after resolution of the HZ mucocutaneous eruptions, and treatment is often only partially effective. Classical trigeminal neuralgia is a severe orofacial neuropathic pain condition characterized by unilateral, brief but recurrent, lancinating paroxysmal pain confined to the distribution of one or more of the branches of the trigeminal nerve. It may be idiopathic or causally associated with vascular compression of the trigeminal nerve root. The anticonvulsive agents, carbamazepine or oxcarbazepine, constitute the first-line treatment. Microvascular decompression or ablative procedures should be considered when pharmacotherapy is ineffective or intolerable. The aim of this short review is briefly to discuss the etiopathogenesis, clinical features, and treatment of PHN and classical trigeminal neuralgia.

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Alexander Mason ◽  
Kristen Ayres ◽  
Sigita Burneikiene ◽  
Alan T. Villavicencio ◽  
E. Lee Nelson ◽  
...  

A 72-year-old female patient is presented, who was diagnosed with herpes zoster along the left ophthalmic branch of the trigeminal nerve with associated cutaneous vesicles. The patient subsequently developed postherpetic neuralgia in the same dermatome, which, after remission, transformed into paroxysmal trigeminal pain. The two different symptom sets, with the former consistent with PHN and the later consistent with trigeminal neuralgia, were unique to our practice and the literature.


2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.


2005 ◽  
Vol 102 ◽  
pp. 107-110 ◽  
Author(s):  
Vasilios A. Zerris ◽  
Georg C. Noren ◽  
William A. Shucart ◽  
Jeff Rogg ◽  
Gerhard M. Friehs

Object.The authors undertook a study to identify magnetic resonance (MR) imaging techniques that can be used reliably during gamma knife surgery (GKS) to identify the trigeminal nerve, surrounding vasculature, and areas of compression.Methods.Preoperative visualization of the trigeminal nerve and surrounding vasculature as well as targeting the area of vascular compression may increase the effectiveness of GKS for trigeminal neuralgia. During the past years our gamma knife centers have researched different MR imaging sequences with regard to their ability to visualize cranial nerves and vascular structures. Constructive interference in steady-state (CISS) fusion imaging with three-dimensional gradient echo sequences (3D-Flash) was found to be of greatest value in the authors' 25 most recent patients.In 24 (96%) out of the 25 patients, the fifth cranial nerve, surrounding vessels, and areas of compression could be reliably identified using CISS/3D-Flash. The MR images were acceptable despite patients' history of microvascular decompression, radiofrequency (RF) ablation, or concomitant disease. In one of 25 patients with a history of multiple RF lesions, the visualization was inadequate due to severe trigeminal nerve atrophy.Conclusions.The CISS/3D-Flash fusion imaging has become the preferred imaging method at the authors' institutions during GKS for trigeminal neuralgia. It affords the best visualization of the trigeminal nerve, surrounding vasculature, and the precise location of vascular compression.


2020 ◽  
Vol 17 (1) ◽  
pp. 82-91
Author(s):  
Hardiyanti ◽  
R Ratianingsih ◽  
Hajar

Varicella and herpes zoster are two infectious skin diseases of human that caused by varicella zoster virus, where varicella disease is a primary infection that often infected younger people while herpes zoster disease is a recurrent disease that often infected older people because of reactivation of latent varicella-zoster virus. If the pain caused by herpes zoster after recurrent phase is a appeared then the condition is known as postherpetic neuralgia. This study builds a mathematical model of primary infection (varicella disease) and recurrent infection (herpes zoster disease) developed from the SIR model (Susceptible, Infected, Recovered). The human population is divided into seven subpopulations, namely susceptible, infection, recovered of varicella, herpes zoster and postherpetic neuralgia subpopulation. Stability analysis at the critical point by linearization method gives a critical point 𝑇1 that guaranted to exist and unstable if 𝛼 𝜇(𝛽1+𝜇) 𝐴 , while the critical point 𝑇1 does not have any reqruitment. Stability analysis at the endemic disease-free critical point is represented 𝑇1 that will be unstable if 𝑇2 exist and stable 𝑇1 if 𝑇2 exist. Numerical simulations by simulated to describe such temporary disease-free conditions and an endemic stable conditions.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lorenzo Stefano Pelloni ◽  
Raffaele Pelloni ◽  
Luca Borradori

Abstract Background Herpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects. Case presentation A 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery. Conclusions Among immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk.


Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 354-359 ◽  
Author(s):  
Selçuk Peker ◽  
Özlem Kurtkaya ◽  
İbrahim Üzün ◽  
M Necmettin Pamir

Abstract OBJECTIVE: The aim of this study was to evaluate the microanatomy of the central myelin-peripheral myelin transitional zone (TZ) in trigeminal nerves from cadavers. METHODS: One hundred trigeminal nerves from 50 cadaver heads were examined. The cisternal portion of the nerve (from the pons to Meckel's cave) was measured. Horizontal sections were stained and photographed. The photomicrographs were used to measure the extent of central myelin on the medial and lateral aspects of the nerve and to classify TZ shapes. RESULTS: The cisternal portions of the specimens ranged from 8 to 15 mm long (mean, 12.3 mm; median, 11.9 mm). The data from the photomicrographs revealed that the extent of central myelin (distance from pons to TZ) on the medial aspect of the nerve (range, 0.1–2.5 mm; mean, 1.13 mm; median, 1 mm) was shorter than that on the lateral aspect (range, 0.17–6.75 mm; mean, 2.47 mm; median, 2.12 mm). CONCLUSION: The data definitively prove that the root entry zone (REZ, nerve-pons junction) and TZ of the trigeminal nerve are distinct sites and that these terms should never be used interchangeably. The measurements showed that the central myelin occupies only the initial one-fourth of the trigeminal nerve length. If trigeminal neuralgia is caused exclusively by vascular compression of the central myelin, the problem vessel would always have to be located in this region. However, it is well known that pain from trigeminal neuralgia can resolve after vascular decompression at more distal sites. This suggests that the effects of surgical decompression are caused by another mechanism.


Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. E974-E975 ◽  
Author(s):  
Jonathan P. Miller ◽  
Feridun Acar ◽  
Kim J. Burchiel

Abstract OBJECTIVE Trigeminal neuralgia (TN) is often associated with neurovascular compression. However, intracranial tumors are occasionally observed, particularly when symptoms are atypical. We describe three patients with Type-1 TN and trigeminal schwannoma diagnosed by magnetic resonance imaging, with concomitant arterial compression of the trigeminal nerve. CLINICAL PRESENTATION All three patients had Type-1 TN with spontaneous onset, paroxysm-triggered pain, and response to antiepileptic medication. Contrast-enhanced T1-weighted magnetic resonance imaging scans demonstrated an ipsilateral enhancing perineural mass consistent with a schwannoma. Two of the three patients had previously undergone gamma knife radiosurgery without improvement. Subsequent high-resolution magnetic resonance imaging in all three patients revealed obvious compression of the trigeminal nerve by an arterial structure. INTERVENTION Two patients underwent retrosigmoid craniectomy followed by microvascular decompression and remain pain-free. One patient elected not to pursue surgical intervention. CONCLUSION Although intracranial tumors are occasionally observed in patients with TN, neurovascular compression must still be considered as an etiology, especially if typical TN symptoms are reported.


2009 ◽  
Vol 14 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Gary J Bennett ◽  
C Peter N Watson

OBJECTIVES: The history behind the current understanding of the varicella-zoster virus and its relationship to the pain conditions caused by shingles and postherpetic neuralgia are reviewed. The framework for the current conceptualization is Hope-Simpson’s latency hypothesis. Data from recent work in virology, neuroanatomy and epidemiology are reviewed, as is work using varicella-zoster virus-infected animals. The recent data largely confirm Hope-Simpson’s hypothesis and extend it significantly.


Mediscope ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 51-57
Author(s):  
Sayema Ainan

Management of chronic pain is one of the most important reason to which medications are given. Traditional medicines which have been used to relieve pain are having a number of limitations. Therefore, novel therapies for pain treatment are essential. Our nervous system can process any kind of injurious stimuli, which is known as nociception. The mechanism of nociception involves a complex interaction of peripheral and central nervous system structures. Brain or cerebral cortex has its own controlling mechanism for pain perception. Trigeminal nerve is the fifth cranial nerve and it receives pain sensation from oro- and craniofacial region and sends the information up to cortex. Recent investigations demonstrate another important role of cortical neurons in addition to pain perception, that is, corticotrigeminal (cortex to trigeminal) pathway excites neurons in the trigeminal nerve that leads to decrease in the pain response induced by noxious stimuli. Thus, as this mechanism can be induced at early stage of nociception, it may reduce the pain sensation. So, the corticotrigeminal pathway could be a new potential target for pain therapies. This short review revisits the concepts how stimulation of primary somatosensory cortex can be transmitted via corticotrigeminal tract which aim for the inhibitory neurons in spinal trigeminal nucleus caudalis (SpVc) and thus potentially generate a feedforward inhibition, explaining the pain modulatory role of the corticotrigeminal pathway. Mediscope Vol. 7, No. 1: Jan 2020, Page 51-57


2016 ◽  
Vol 206 (3) ◽  
pp. 595-600 ◽  
Author(s):  
Marion A. Hughes ◽  
Andrew M. Frederickson ◽  
Barton F. Branstetter ◽  
Xiao Zhu ◽  
Raymond F. Sekula

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