高雄医学大学神经内科.pptVIP

Glossopharyngeal neuralgia A rare cranial neuralgia Characteristics: Paroxysms of deep stabbing pain in one side of the throat (oropharynx, the tongue base, tonsillar fossa or from pharynx to the ear) The attacks may present in clusters that last from weeks to months Often triggered by swallowing, chewing, talking, cough, and head turning Bradycardia, hypotension, or syncope may occur Glossopharyngeal neuralgia Etiology: Glossopharyngeal nerve compression by the artery Secondary: multiple sclerosis… Treatment: as trigeminal neuralgia Postherpetic neuralgia Facial pain that develops during the acute phase of herpes zoster and persists for 3 months after the skin eruption has resolved Most common in the immunocompromised or elderly patients The 1st division of trigeminal nerve (V1) is involved Paroxysmal lancinating or continuous, deep, burning pain allodynia Risks factors of postherpetic neuralgia Age Greater acute pain severity Greater rash severity Sensory dysfunction in the affected dermatome during acute HZ Presence of a painful prodrome preceding the rash More pronounced humoral and cell-mediated immune responses Fever Generalized impairment of large fiber afferents Psychosocial distress International anesthesiology clinics. 2003 vol. 41 (3) pp. 115-50 Postherpetic neuralgia Treatment: Anti-viral agent steroid early treatment accelerates healing and reduce the duration of pain Tricyclic antidepressants Anti-convulsants: gabapentin, pregabalin Opioids, tramadol, NSAIDs Lidocaine patch or other topical agents Temporomandibular dysfunction Symptoms: Pain usually localized to the TMJ, the pre-auricular area, or muscles of mastication Headache neck pain Pain triggered or worsened by jaw movement Limited ROM or asymmetric jaw movementClicking with jaw excursionLocking on open the mouth Signs: Joint masticatory muscle tenderness, clicking on mouth opening, limited ROM of TMJ Temporomandibular dysfunction Possible etiology: Joint degeneration, bruxism, tra