Clin J Pain 2002 Mar;18(1):14-21 Related Articles, Books, LinkOut
Diagnosis and differential diagnosis
of trigeminal neuralgia.
Zakrzewska JM.
Barts and the London, Queen Mary's
School of Medicine and Dentistry, London, England, U.K.
Trigeminal neuralgia is a chronic
facial pain classified as a neuropathic pain.
There is widespread agreement regarding
the International Association for the Study of Pain definition of classical
idiopathic trigeminal neuralgia as "a sudden, usually unilateral, severe,
brief, stabbing, recurrent pain in the distribution of one or more branches
of the fifth cranial nerve."
However, there are variations in
presentation that are less easy to diagnose and an erroneous diagnosis
of trigeminal neuralgia is occasionally made.
In patients with tumors or multiple
sclerosis, trigeminal neuralgia is termed secondary.
Currently, clinical manifestations
are the mainstay for diagnosis because there are no objective tests to
validate the diagnosis.
The sensitivity and specificity of
these clinical manifestations is reviewed.
Magnetic resonance imaging (MRI)
and three-dimensional fast-in-flow with steady-state precession MRI are
performed to determine the presence of tumors or plaques of multiple sclerosis
and to assess possible compressions and deformations of the trigeminal
nerve.
Their specificity and sensitivity
regarding compressions found at the time of surgery is reviewed.
Other differential diagnoses for
chronic unilateral orofacial pain are discussed.