scholarly journals Neurotrophic Keratopathy after Trigeminal Nerve Block for Treatment of Postherpetic Neuralgia

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Aya Kodama-Takahashi ◽  
Koji Sugioka ◽  
Tomoko Sato ◽  
Koichi Nishida ◽  
Keiichi Aomatsu ◽  
...  
Keyword(s):  
Nerve Block ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Nerve Fibers ◽  
Gasserian Ganglion ◽  
Ganglion Block ◽  
Corneal Epithelial ◽  
Corneal Sensation ◽  
The Right ◽  
Neurotrophic Keratopathy

Purpose. To report a case of persistent corneal epithelial defect that had occurred after a trigeminal nerve block. Case Presentation. A 75-year-old female had suffered from postherpetic neuralgia for 8 years. She underwent Gasserian ganglion block surgery and noticed declining visual acuity in the right eye on the following day. She presented with severe hyperemia and corneal epithelial defects in the right eye and experienced remarkable reduction of sensitivity in the right cornea. She was diagnosed with neurotrophic keratopathy. Ofloxacin eye ointment and rebamipide ophthalmic suspension ameliorated the corneal epithelial defects but superficial punctate keratopathy, corneal superficial neovascularization, and Descemet’s fold persisted. Although the epithelial defects occasionally recurred, the corneal sensation and epithelial defects, Descemet’s fold, and corneal superficial neovascularization all improved around 5 months after trigeminal nerve block. The HRT II Rostock Cornea Module (RCM) could not detect any corneal subbasal nerve fibers at postoperative 4 months; however, it could detect them at postoperative 6 months. Conclusions. As the nerve block effect wore off, the corneal subbasal nerve fibers slowly regenerated. As the corneal sensation improved, the corneal epithelial defects and superficial neovascularization also improved. The HRT II RCM appeared useful for observing loss and regeneration of the corneal subbasal nerve fibers.

scholarly journals Severe Headache with Eye Involvement from Herpes Zoster Ophthalmicus, Trigeminal Tract, and Brainstem Nuclei

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Sasitorn Siritho ◽  
Wadchara Pumpradit ◽  
Wiboon Suriyajakryuththana ◽  
Krit Pongpirul
Keyword(s):  
Trigeminal Nerve ◽  
Maculopapular Rash ◽  
Cervical Cord ◽  
Gasserian Ganglion ◽  
Herpes Zoster Ophthalmicus ◽  
Trigeminal Nuclei ◽  
Upper Cervical ◽  
Sensory Nucleus ◽  
The Right ◽  
Orbital Imaging

A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10–15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V.

scholarly journals Trigeminal Neuralgia associated with Wallenberg Syndrome, a case report

2021 ◽  
Author(s):  
Matheus Goncalves Maia ◽  
Vivian Dias Baptista Gagliardi ◽  
Francisco Tomaz Meneses Oliveira ◽  
Eduardo dos Santos Sousa ◽  
Marina Trombin Marques ◽  
...  
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Vascular Compression ◽  
Gasserian Ganglion ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Initial Event ◽  
The Right ◽  
The Brain

Context: Trigeminal neuralgia is typically associated with structural lesions that affect the brainstem, pre-ganglionic roots, gasserian ganglion and the trigeminal nerve. The association of trigeminal neuralgia with infarction of the dorsolateral medulla is rare, being more associated with pontine lesions, in the context of brainstem infarction. Methods: Report the case of a 55-year-old male patient, who presented with a left dorsolateral bulbar infarction, and developed a ipsilateral trigeminal neuralgia afterwards. Case report: A 55-year-old man attended to the emergency room referring sudden incoordination of the left limbs, associated with numbness of the contralateral limbs. The neurological examination showed nystagmus, numbness of the left face, ataxia of the left limbs and numbness of the right limbs. The Magnetic Resonance of the Brain revealed an area of recent infarction in the left posterolateral aspect of the medulla. He underwent thrombolysis, evolving with complete resolution of symptoms. In the week after the initial event, he returned to the outpatient clinic, reporting paroxysms of excruciating pain in the upper lip, nose and left zygomatic region, being diagnosed with neuralgia of the maxillary segment of the trigeminal nerve, improving with introduction of Gabapentin. Conclusion: Although most cases of trigeminal neuralgia are determined by vascular compression of the trigeminal nerve root entry zone, other causes must be considered. The association of this condition with dorsolateral medulla infarction is rare, with only 4 cases reported in the last 10 years.

Treatment of neurotrophic keratopathy with minimally invasive corneal neurotisation: long-term clinical outcomes and evidence of corneal reinnervation

2019 ◽  
pp. bjophthalmol-2018-313042 ◽  
Author(s):  
Joseph Catapano ◽  
Simon S M Fung ◽  
William Halliday ◽  
Cecilia Jobst ◽  
Douglas Cheyne ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Immunohistochemical Analysis ◽  
Corneal Opacity ◽  
Sensory Nerves ◽  
Alternative Source ◽  
Corneal Epithelial ◽  
Corneal Sensation ◽  
Neurotrophic Keratopathy

AimTo report clinical outcomes and evidence of corneal innervation in patients with neurotrophic keratopathy (NK) treated with minimally invasive corneal neurotisation (MICN) using a sural nerve graft and donor sensory nerves from the face.MethodsPatients undergoing MICN at The Hospital for Sick Children, Toronto, Canada were prospectively recruited. Data on central corneal sensation (CCS, measured with Cochet-Bonnet aesthesiometer), best-corrected visual acuity (BCVA) and corneal epithelial integrity were collected. In four patients who subsequently underwent keratoplasty, immunohistochemical analysis was performed on the corneal explants. One patient underwent magnetoencephalography (MEG) after MICN to characterise the neurophysiological pathways involved.ResultsBetween November 2012 and February 2017, 19 eyes of 16 patients underwent MICN. Mean follow-up was 24.0±16.1 months (range, 6–53). Mean CCS significantly improved from 0.8±2.5 mm to 49.7±15.5 mm at final follow-up (p<0.001). Mean BCVA remained stable, and the number of episodes of corneal epithelial defects after MICN was significantly reduced compared with the year leading up to the procedure (21% vs 89%, respectively; p<0.0001). In the four eyes that underwent keratoplasties after MICN, all transplants fully re-epithelialised and regained sensation subsequently. Immunohistochemistry of the corneal explants demonstrated evidence of corneal reinnervation. In one patient who was 8 months after MICN, novel neuroactivity was detected on MEG in the ipsilateral somatosensory cortex on mechanical stimulation of the reinnervated cornea.ConclusionsBy providing an alternative source of innervation, MICN improves corneal sensation and stabilises the corneal epithelium, permitting optical keratoplasty for patients with NK-related corneal opacity.

Pain Management Techniques

2017 ◽  
Author(s):  
Maureen F. McClenahan ◽  
William Beckman
Keyword(s):  
Pain Management ◽  
Nerve Block ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Gasserian Ganglion ◽  
Medial Branch ◽  
Celiac Plexus Block ◽  
Ganglion Block ◽  
Management Procedures ◽  
Plexus Block

This chapter provides a broad review of various interventional pain management procedures with a focus on indications, anatomy, and complications. Specific techniques reviewed include transforaminal epidural steroid injection, lumbar sympathetic block, stellate ganglion block, cervical and lumbar radiofrequency ablation, gasserian ganglion block, sacroiliac joint injection, celiac plexus block, lateral femoral cutaneous nerve block, ilioinguinal block, lumbar medial branch block, obturator nerve block, ankle block, occipital nerve block, superior hypogastric plexus block, spinal cord stimulation, and intrathecal drug delivery systems. The chapter reviews contrast agents, neurolytic agents, botulinum toxin use, corticosteroids, and ziconotide pharmacology and side effects in addition to diagnosis and management of local anesthetic toxicity syndrome. It also discusses indications for neurosurgical techniques including dorsal root entry zone lesioning. In addition, information on radiation safety and the use of anticoagulants with neuraxial blocks is covered.

scholarly journals Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

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.

Morphological signs of neurogenic inflammation in the heart of rats during aging

2022 ◽  
pp. 831-840
Author(s):  
Е.И. Чумасов ◽  
Е.С. Петрова ◽  
Д.Э. Коржевский
Keyword(s):  
Neurogenic Inflammation ◽  
Plasma Cells ◽  
Nerve Fibers ◽  
Blood Capillaries ◽  
Pgp 9.5 ◽  
Sympathetic Nerve Fibers ◽  
Close Relationship ◽  
The Right ◽  
Inflammatory Infiltrates ◽  
Heart Apparatus

С помощью гистологических методов окраски толуидиновым синим, гематоксилином и эозином и иммуногистохимических реакций на белок PGP 9.5, тирозингидроксилазу (ТГ), белок Iba-1, изучены клеточные изменения в разных отделах сердца крыс линии Wistar в возрасте 18- 23 мес. В соединительной ткани основания сердца обнаружены очаговые воспалительные инфильтраты, внутри которых выявлены PGP 9.5 и ТГ сплетения, состоящие из парасимпатических и симпатических нервных волокон. В области клапанного аппарата, на границе фиброзного кольца и миокарда правого предсердия, обнаружены патологические изменения нервных структур - дегенерация нервных пучков и зернистый распад варикозных аксонов терминального сплетения. Установлены тесные взаимоотношения аксонов терминальной нервной сети с клетками воспалительных инфильтратов и кровеносными сосудами. Определены закономерности встречаемости в различных отделах миокарда у старых животных нейроклеточных воспалительных комплексов, состоящих из нервных волокон, кровеносных капилляров и клеток-участников местного воспалительного процесса (тучных клеток, макрофагов, фибробластов, плазмоцитов). Установлен хронический характер нейрогенного воспаления в сердце при старении. Using histological methods of staining with toluidine blue, hematoxylin-eosin and immunohistochemical reactions for the PGP 9,5 protein, tyrosine hydroxylase (TH), Iba-1 protein, cellular changes in different parts of the heart of Wistar rats at the age of 18-23 months were studied. In the connective tissue of the heart base, focal inflammatory infiltrates were found, near which PGP 9.5 and TH plexuses, consisting of parasympathetic and sympathetic nerve fibers, were detected. In the area of the valvular heart apparatus, at the border of the anneau fibreux and the myocardium of the right atrium, pathological changes in nerve structures were found: degeneration of nerve fibers and granular destruction varicose axons of the terminal plexus. A close relationship has been established between axons of the terminal nervous network and cells of inflammatory infiltrates and blood capillaries. The features of the localization of neurocellular inflammatory complexes consisting of nerve fibers, blood capillaries and cells participating in the local inflammatory process (mast cells, histiocytes, monocytes, fibroblasts, plasma cells) in various parts of the myocardium in old animals are described. The chronic nature of neurogenic inflammation in the heart during aging has been established.

scholarly journals Gasserian Ganglion Block

Pain Medicine ◽  
2017 ◽  
pp. 279-283
Author(s):  
Maureen F. McClenahan ◽  
M. Gabriel Hillegass
Keyword(s):  
Gasserian Ganglion ◽  
Ganglion Block

scholarly journals STUDIES ON ENTRY AND EGRESS OF POLIOMYELITIS INFECTION

1950 ◽  
Vol 92 (6) ◽  
pp. 571-589 ◽  
Author(s):  
Harold K. Faber ◽  
Rosalie J. Silverberg ◽  
Lester A. Luz ◽  
Luther Dong
Keyword(s):  
Alimentary Tract ◽  
Secondary Phase ◽  
Blood Stream ◽  
Nerve Fibers ◽  
The Body ◽  
Infraorbital Nerve ◽  
Gasserian Ganglion ◽  
Neural Connections ◽  
Axonal Conduction ◽  
Initial Stage

Excretion of poliomyelitis virus has been demonstrated in monkeys after four different parenteral routes of inoculation. Virus has been found in both the pharyngeal secretions and the stools after infraorbital nerve dip and after inoculation of the Gasserian ganglion; in the pharyngeal secretions after intrathalamic inoculation; and in the stools after inoculation of the celiac ganglion. Excretion began as early as the 2nd and as late as the 7th day after inoculation, in all instances before the onset of symptoms. The immediate source of the excreted virus appeared to be infected peripheral ganglia with neural connections to the mucous membranes of the upper and lower portions of the alimentary tract, notably the pharynx. Primary infection of the body surfaces was excluded in the experiments and therefore could not account for the excretion of virus. The mode of elimination was probably by centrifugal spread through axons of peripheral nerve fibers and not by way of the blood stream or lymphatics. Evidence was obtained that when excretion of virus has once occurred, reinvasion from the implicated surface to other, previously uninfected peripheral ganglia ensues, thus providing new sources for excretion and other potential pathways for invasion of the CNS. It is suggested that such reinvasion may occur serially until the immunological defenses come into play. Our experiments lend support to the view that during the initial stage of poliomyelitis, and perhaps throughout its course in some cases, e.g. the asymptomatic and the mild cases without central nervous symptoms, infection is confined to the peripheral nervous system. Involvement of the CNS when it occurs is a secondary phase of the infective process and is not a necessary prelude to elimination of the virus. Excretion is explainable on the basis of the established neurocytotropism and axonal conduction of the virus without resort to the hypothesis of extraneural infection.

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