1/4. Post-apopletic trigeminal trophic syndrome.Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo-anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction. diagnosis by scrape cytology in ruling-out basal cell carcinoma and other ulcerative skin diseases is discussed and the importance of neurological examination in disclosing hemi-anaesthesia of trigeminal dermatome(s) is emphasized.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism.We report two cases of SUNCT that demonstrate the medically and surgically refractory nature of this disorder and support the hypothesis that the causative 'lesion' lies within the central nervous system. After both patients had failed medical therapies, the first underwent a glycerol rhizotomy, gammaknife radiosurgery and microvascular decompression of the trigeminal nerve. The second patient underwent gammaknife radiosurgery of the trigeminal root exit zone and two microvascular decompression surgeries. Neither patient benefited from these procedures. Currently, the first patient suffers from anaesthesia dolorosa and the second patient from unilateral deafness, chronic vertigo and dysequilibrium as a result of surgical trauma. These cases of SUNCT highlight the uncertainty regarding the role of surgery given the potential for significant morbidity. These cases also suggest that SUNCT originates and may be maintained from within the CNS and this central locus explains why SUNCT is not typically amenable to interventions aimed at the peripheral portion of the trigeminal nerve.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/4. Bilateral trigeminal neuralgia.A 56-year-old woman previously treated by a retrogasserian neurectomy for a right tic douloureux was rendered free of pain, but complete anaesthesia of the right half of her face remained. Seven years later, she developed a typical left trigeminal neuralgia. Contralateral rhizotomy was refused because of the patient's concern about having bilateral facial anaesthesia. Through a suboccipital craniectomy, the trigeminal nerve was decompressed from a thickened arachnoid membrane and a large bridging vein near the root entry zone. After eighteen months, the patient was free of pain with intact facial sensations on the left side. Therapeutic considerations in cases of bilateral trigeminal neuralgia are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. Chronic precentral stimulation in trigeminal neuropathic pain.The results of deep brain stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7 cases using Motor-Cortex-Stimulation for treating severe trigeminal neuropathic pain syndromes, i.e., dysaesthesia, anaesthesia dolorosa and postherpetic neuralgia. The first implantation of the stimulation device for precentral cerebral stimulation was performed in June 1993, the last in September 1995. In all but one case the impulse-generator was implanted after a successful period of test stimulation. Successful means a pain reduction of more than 50% as assessed with a Visual Analogue Scale. Excluding one case, in whom a prolonged focal seizure resulting in a postictal speech arrest occurred during test stimulation, there have been no operative complications and the postoperative course was uneventful. In all the other patients the pain inhibition appeared below the threshold for producing motor effects. Initially these patients reported a good to excellent pain relief. In three of 6 patients a good to excellent pain control was maintained for a follow-up period of 5 months to 2 years. In the remaining three patients the positive effect decreased over several months.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |