Cargando…

A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department

This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and...

Descripción completa

Detalles Bibliográficos
Autores principales: Copp, Sebastian R, LeBlanc, Constance
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407718/
https://www.ncbi.nlm.nih.gov/pubmed/30891372
http://dx.doi.org/10.7759/cureus.3831
_version_ 1783401611654070272
author Copp, Sebastian R
LeBlanc, Constance
author_facet Copp, Sebastian R
LeBlanc, Constance
author_sort Copp, Sebastian R
collection PubMed
description This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and stabbing in nature, lasting only seconds, and occurring over intervals of a few minutes. His vital signs, including glucose, were normal. He had no constitutional symptoms, a normal neurological examination, and a normal head, eyes, ears, nose, and throat examination. The painful paroxysms could not be elicited on palpation of his face, head, or oral mucosa. His blood investigations were reported as within normal limits. He was not using alcohol or any illicit drugs and was not taking any medication. A diagnosis, with supportive imaging, of ophthalmic branch trigeminal neuralgia (TN) was made. His pain responded well to treatment with carbamazepine. TN is characterized by brief and intermittent lancinating pain with or without a constant background level of pain in the sensory distribution of one or more branches of the trigeminal nerve. There are three main causes for TN: idiopathic, the classical type resulting from neurovascular compression, and the secondary type typically due to multiple sclerosis, a space-occupying lesion, or a skull base abnormality. The mandibular and maxillary branches are most affected and can often be affected simultaneously. Ophthalmic branch TN is relatively rare. Virtually all of TN cases are unilateral and most are the classical type. Distinguishing TN from other cephalalgias, ocular pain, dental pain, or other pathology is critical to a proper diagnosis and initiation of effective therapy. Identifying trigger zones is important and carries a high diagnostic yield; however, they may be anatomically difficult to access, or in a refractory period during a physical examination. Physicians should be aware of several red flags associated with a suspected case of TN. Carbamazepine is the first-line treatment for TN, capable of reducing pain in 90% of patients. Failure to respond to medication requires further investigation and/or specialist referral. Untreated or unrecognized TN can have significant impacts on a patient’s quality of life.
format Online
Article
Text
id pubmed-6407718
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-64077182019-03-19 A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department Copp, Sebastian R LeBlanc, Constance Cureus Emergency Medicine This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and stabbing in nature, lasting only seconds, and occurring over intervals of a few minutes. His vital signs, including glucose, were normal. He had no constitutional symptoms, a normal neurological examination, and a normal head, eyes, ears, nose, and throat examination. The painful paroxysms could not be elicited on palpation of his face, head, or oral mucosa. His blood investigations were reported as within normal limits. He was not using alcohol or any illicit drugs and was not taking any medication. A diagnosis, with supportive imaging, of ophthalmic branch trigeminal neuralgia (TN) was made. His pain responded well to treatment with carbamazepine. TN is characterized by brief and intermittent lancinating pain with or without a constant background level of pain in the sensory distribution of one or more branches of the trigeminal nerve. There are three main causes for TN: idiopathic, the classical type resulting from neurovascular compression, and the secondary type typically due to multiple sclerosis, a space-occupying lesion, or a skull base abnormality. The mandibular and maxillary branches are most affected and can often be affected simultaneously. Ophthalmic branch TN is relatively rare. Virtually all of TN cases are unilateral and most are the classical type. Distinguishing TN from other cephalalgias, ocular pain, dental pain, or other pathology is critical to a proper diagnosis and initiation of effective therapy. Identifying trigger zones is important and carries a high diagnostic yield; however, they may be anatomically difficult to access, or in a refractory period during a physical examination. Physicians should be aware of several red flags associated with a suspected case of TN. Carbamazepine is the first-line treatment for TN, capable of reducing pain in 90% of patients. Failure to respond to medication requires further investigation and/or specialist referral. Untreated or unrecognized TN can have significant impacts on a patient’s quality of life. Cureus 2019-01-06 /pmc/articles/PMC6407718/ /pubmed/30891372 http://dx.doi.org/10.7759/cureus.3831 Text en Copyright © 2019, Copp et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
Copp, Sebastian R
LeBlanc, Constance
A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title_full A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title_fullStr A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title_full_unstemmed A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title_short A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department
title_sort case of ophthalmic branch trigeminal neuralgia in the emergency department
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407718/
https://www.ncbi.nlm.nih.gov/pubmed/30891372
http://dx.doi.org/10.7759/cureus.3831
work_keys_str_mv AT coppsebastianr acaseofophthalmicbranchtrigeminalneuralgiaintheemergencydepartment
AT leblancconstance acaseofophthalmicbranchtrigeminalneuralgiaintheemergencydepartment
AT coppsebastianr caseofophthalmicbranchtrigeminalneuralgiaintheemergencydepartment
AT leblancconstance caseofophthalmicbranchtrigeminalneuralgiaintheemergencydepartment