Abstract
A 74-year-old woman had a 5-year history of constant burning pain and numbness of the control face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving were present. Oral administration of 500 mg L-dopa aggravated her pain and produced transient hypalgesia in the C2 through C5 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers. In conclusion: (1) Only the central region of the face is exclusively supplied by the trigeminal nerves. (2) Somato-autonomic reflexes coupled with electrophysiological studies localized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 522-526 |
| Number of pages | 5 |
| Journal | Headache |
| Volume | 37 |
| Issue number | 8 |
| DOIs | |
| State | Published - Sep 1 1997 |
| Externally published | Yes |
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Keywords
- Facial pain
- Facial sensation
- Infraorbital nerve biopsy
- Somato-autonomic reflexes
- Trigeminal neuropathy
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
Cite this
Painful trigeminal neuropathy : Clinical and pharmacological observations. / Khurana, Ramesh; Mayer, Richard F.
In: Headache, Vol. 37, No. 8, 01.09.1997, p. 522-526.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Painful trigeminal neuropathy
T2 - Clinical and pharmacological observations
AU - Khurana, Ramesh
AU - Mayer, Richard F.
PY - 1997/9/1
Y1 - 1997/9/1
N2 - A 74-year-old woman had a 5-year history of constant burning pain and numbness of the control face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving were present. Oral administration of 500 mg L-dopa aggravated her pain and produced transient hypalgesia in the C2 through C5 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers. In conclusion: (1) Only the central region of the face is exclusively supplied by the trigeminal nerves. (2) Somato-autonomic reflexes coupled with electrophysiological studies localized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.
AB - A 74-year-old woman had a 5-year history of constant burning pain and numbness of the control face of subacute onset. The central region of the face, oral cavity, and nose lacked all sensation. Corneal reflexes and the jaw jerk were absent. Blood tests, rectal biopsy, neurodiagnostic studies, and surgical exploration of the trigeminal nerve were normal. Blink reflexes were absent. Facial nerve motor latencies and EMG of the facial and masseter muscles were normal. Responses to the thermoregulatory sweat test, intradermal histamine, and simulated diving were present. Oral administration of 500 mg L-dopa aggravated her pain and produced transient hypalgesia in the C2 through C5 dermatomes. Infraorbital nerve biopsy demonstrated loss of large myelinated fibers. In conclusion: (1) Only the central region of the face is exclusively supplied by the trigeminal nerves. (2) Somato-autonomic reflexes coupled with electrophysiological studies localized the lesion to the large fibers. (3) Large fiber loss and central brain stem reorganization may explain the burning pain. (4) Dopamine may modulate trigeminal nociception.
KW - Facial pain
KW - Facial sensation
KW - Infraorbital nerve biopsy
KW - Somato-autonomic reflexes
KW - Trigeminal neuropathy
UR - http://www.scopus.com/inward/record.url?scp=0030762072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030762072&partnerID=8YFLogxK
U2 - 10.1046/j.1526-4610.1997.3708522.x
DO - 10.1046/j.1526-4610.1997.3708522.x
M3 - Article
C2 - 9329237
AN - SCOPUS:0030762072
VL - 37
SP - 522
EP - 526
JO - Headache
JF - Headache
SN - 0017-8748
IS - 8
ER -