三叉神经痛幻灯片.ppt

(Trigeminal Neuralgia, TN) 一、概 述 Clinic Pathology of TN A sharp, severe, shooting pain It usually comes and goes Affect adults of any age, although some types are more common after middle age. Might be caused by irritation or damage to a nerve, although the cause of the irritation is often not known. Irritation could be caused by An infection such as tooth decay Herpes zoster virus (shingles) Nasal infections Eye strain Systemic diseases Arthritis Exposure to cold A pinched nerve Injury Poor diet Diagnosis Take a complete medical history and perform a physical examination basing upon the location of your pain and its characteristic symptoms Look for an underlying cause of your symptoms Facial pain- jaw, teeth, or sinuses Check whether a tumor or aneurysm is putting pressure on a nerve Therapies Agents -Antiseizure drugs carbamazepine Phenytoin Procedures to deaden the nerve with gamma rays, radio frequency waves, or glycerol injections The nerve can also be cut or permanently destroyed Surgery to free the nerve Alternative treatments B-complex vitamin Acupuncture Herbal remedies Self-care tips To avoid attacks if you know what triggers them Avoid very cold or very hot food and drinks Don’t chew your food on the side that is painful Don’t eat extremely hard or crunchy foods Avoid splashing your face with very hot or cold water when washing Rinse your mouth with water after every meal instead of using a toothbrush 二、分类 分为原发性、继发性三叉神经痛 原发性三叉神经痛无明显原因，由三叉神经本身的潜在病变引起，检查无神经系统体征，部分为邻近正常血管压迫所致 继发性三叉神经痛源于三叉神经节邻近组织病变 桥小脑角肿瘤 三叉神经根或半月神经节部位的肿瘤 血管畸形 动脉瘤 蛛网膜炎等 1、原发性三叉神经痛 Primary trigeminal neuralgia, PTN 病史，疼痛部位、性质，全身营养，白天发作 表情痛苦，面部油腻，不愿讲话 神经系统检查正常，感觉、运动及反射（角膜，下颌）反射均无异常 治疗后可有局部痛觉减退，应与继发性三叉神经痛的面部感觉减退相鉴别 影像学无异常改变 2、继发性三叉神经痛 Secondary trigeminal neuralgia, STN 又称症状性三叉神经痛，是由于颅内、外器质性疾病引起的三叉神经痛 疼痛程度较轻 疼痛发作的持续时间较长 或呈持续性痛，阵发性加重 多见于40岁以下中、青年人 通常没有扳机点 诱发因素不明显 脑脊液、X线颅底摄片、CT或MRI检查、鼻咽部活组织检查等有助诊断 三、PTN临床特点 1.性别与年龄：年龄多40岁，男女性别比例约为3∶2 2.疼痛部位：右侧多于左侧，疼痛由面部