Neuralgia nerwu trójdzielnego – Etiologia i przyczyny

Neuralgia nerwu trójdzielnego
Etiologia i przyczyny

Neuralgia nerwu trójdzielnego charakteryzuje się nawracającymi, jednostronnymi epizodami bólu o charakterze „uderzenia pioruna” w obszarze unerwianym przez nerw trójdzielny. Klasyczna neuralgia jest najczęściej spowodowana uciskiem naczyniowym na korzeń nerwu w okolicy wejścia do pnia mózgu, co prowadzi do miejscowej demielinizacji i ektopowego generowania impulsów. W 80-90% przypadków ucisk wywołuje tętnica móżdżkowa górna (75-80%), a inne naczynia to żyła skalista, tętnica móżdżkowa dolna przednia oraz tętnica kręgowa. Wtórna neuralgia wynika z chorób takich jak stwardnienie rozsiane (2-4% pacjentów z neuralgią), guzy (oponiaki, nerwiaki, torbiele epidermoidalne), malformacje naczyniowe, tętniaki, a także urazy i zabiegi chirurgiczne uszkadzające osłonkę mielinową nerwu trójdzielnego.

Etiologia neuralgii nerwu trójdzielnego

Klasyczna neuralgia nerwu trójdzielnego
Wtórna neuralgia nerwu trójdzielnego
Czynniki ryzyka
Mechanizmy patofizjologiczne
Idiopatyczna neuralgia nerwu trójdzielnego
Kolejne rozdziały

Etiologia neuralgii nerwu trójdzielnego

Neuralgia nerwu trójdzielnego to wyjątkowo bolesny zespół charakteryzujący się nawracającymi, krótkimi epizodami jednostronnego bólu w obszarze unerwianym przez nerw trójdzielny. Ból ten jest często opisywany jako „uderzenie pioruna” w twarz i może być wywołany przez codzienne czynności, takie jak mycie twarzy, szczotkowanie zębów czy nawet lekki powiew wiatru¹². Zrozumienie etiologii tej choroby jest kluczowe dla właściwego leczenia i postępowania z pacjentami.

Klasyczna neuralgia nerwu trójdzielnego

Klasyczna (pierwotna) neuralgia nerwu trójdzielnego jest najczęściej spowodowana uciskiem naczynia krwionośnego na korzeń nerwu trójdzielnego w okolicy jego wejścia do pnia mózgu³⁴. W 80-90% przypadków, korzeń nerwowy jest uciskany przez sąsiadujące naczynie tętnicze lub żylne⁵. Tętnica móżdżkowa górna jest zaangażowana w 75-80% tych przypadków, co czyni ją najczęstszą przyczyną klasycznej neuralgii nerwu trójdzielnego⁶⁷.

Inne naczynia krwionośne, które mogą uciskać korzeń nerwu trójdzielnego i powodować neuralgię, obejmują:⁸

Żyłę skalistą
Tętnicę móżdżkową dolną przednią
Tętnicę kręgową

⁹

Mechanizm patofizjologiczny w klasycznej neuralgii nerwu trójdzielnego polega na tym, że nacisk naczynia na nerw prowadzi do miejscowej demielinizacji w strefie wejścia korzenia nerwowego do pnia mózgu¹⁰. Ta demielinizacja może powodować ektopowe generowanie impulsów (przekaz efaptyczny) i/lub odhamowanie centralnych szlaków bólowych obejmujących jądro rdzeniowe nerwu trójdzielnego¹¹.

Wtórna neuralgia nerwu trójdzielnego

Wtórna neuralgia nerwu trójdzielnego jest określeniem używanym, gdy ból jest spowodowany inną chorobą lub problemem medycznym¹². Najczęstsze przyczyny wtórnej neuralgii nerwu trójdzielnego obejmują:

Stwardnienie rozsiane

Stwardnienie rozsiane (SM) jest istotnym czynnikiem ryzyka rozwoju neuralgii nerwu trójdzielnego i stanowi podstawową etiologię w około 2-4% objawowych pacjentów¹³. Demielinizacja osłonki mielinowej w przebiegu SM może wpływać na czynność nerwu trójdzielnego i prowadzić do neuralgii¹⁴¹⁵. Neuralgia nerwu trójdzielnego występuje u około 34% osób ze stwardnieniem rozsianym, według danych z siedmiu badań¹⁶.

Guzy i zmiany uciskające

Ucisk nerwu trójdzielnego może być również spowodowany zmianami patologicznymi, takimi jak:¹⁷

Oponiaki
Nerwiaki nerwu słuchowego
Torbiele naskórkowe (epidermoidalne)
Malformacje tętniczo-żylne
Tętniaki workowate

¹⁸¹⁹

Guzy w okolicy kąta mostowo-móżdżkowego są najczęstszymi zmianami nowotworowymi powodującymi neuralgię nerwu trójdzielnego²⁰. W rzadkich przypadkach, neuralgię mogą również powodować guzy w pniu mózgu, takie jak glejaki lub glejaki wielopostaciowe²¹.

Przyczyny naczyniowe

Oprócz ucisku naczyniowego w klasycznej neuralgii, wtórna neuralgia nerwu trójdzielnego może być również spowodowana:²²

Zawałem mostu
Malformacjami tętniczo-żylnymi
Tętniakami w pobliżu nerwu

²³

Uraz i chirurgia

Neuralgia nerwu trójdzielnego może być również wynikiem urazu twarzy, udaru lub zabiegu chirurgicznego, który uszkadza osłonkę mielinową chroniącą nerw trójdzielny²⁴²⁵. Szczególnie zabiegi stomatologiczne, operacje zatok lub inne procedury w obrębie twarzy mogą prowadzić do uszkodzenia nerwu i rozwoju neuralgii²⁶.

Inne przyczyny zapalne i infekcyjne

Inne, rzadsze przyczyny neuralgii nerwu trójdzielnego obejmują:²⁷

Sarkoidozę
Boreliozę (choroba z Lyme)
Półpasiec i neuralgię popółpaścową (zespół Ramsaya Hunta typu 2)²⁸
Infiltrację amyloidową²⁹

Czynniki ryzyka

Istnieje kilka czynników, które mogą zwiększać ryzyko rozwoju neuralgii nerwu trójdzielnego:³⁰

Nadciśnienie tętnicze
Palenie tytoniu
Wiek (częściej u osób powyżej 50 roku życia)
Płeć żeńska (kobiety chorują częściej niż mężczyźni)
Rodzinne występowanie neuralgii nerwu trójdzielnego

Neuralgia nerwu trójdzielnego może również mieć tendencję do występowania rodzinnego, prawdopodobnie ze względu na dziedziczny wzorzec nieprawidłowego tworzenia naczyń krwionośnych³¹³².

Mechanizmy patofizjologiczne

Głównym mechanizmem patofizjologicznym w neuralgii nerwu trójdzielnego jest demielinizacja³³. Obecne teorie dotyczące przyczyny tej demielinizacji koncentrują się na ucisku naczyniowym korzenia nerwowego przez nieprawidłowe lub kręte naczynia³⁴.

„Hipoteza zapłonu”, zaproponowana przez Devora i wsp., ma na celu skorelowanie zmian strukturalnych z napadami bólu, które są charakterystyczne dla tego schorzenia³⁵. Gromadzą się dowody, że napięciowo-zależne kanały sodowe (VGSCs) odgrywają kluczową rolę w generowaniu aktywności ektopowej w aferentnych włóknach nerwu trójdzielnego³⁶.

Badania kliniczne wykazały, że pacjenci z neuralgią nerwu trójdzielnego prezentują ten sam profil dysregulacji kanałów sodowych. Zmiana metioniny w pozycji 136 na walinę (M136V) prowadzi do zwiększenia szczytowego prądu, bez zmiany jakichkolwiek właściwości biofizycznych kanału³⁷. W związku z tym, kanały sodowe zależne od napięcia są uważane za główny cel kontroli bólu w neuralgii nerwu trójdzielnego³⁸.

Idiopatyczna neuralgia nerwu trójdzielnego

W niektórych przypadkach nie można zidentyfikować żadnej oczywistej przyczyny neuralgii nerwu trójdzielnego – taka sytuacja określana jest jako idiopatyczna neuralgia nerwu trójdzielnego³⁹⁴⁰. Ani badania elektrofizjologiczne, ani obrazowanie MRI nie wykazują wtedy znaczących nieprawidłowości⁴¹.

Warto podkreślić, że mimo intensywnych badań, pełne zrozumienie etiologii neuralgii nerwu trójdzielnego pozostaje wyzwaniem dla współczesnej medycyny. Wiele przypadków może mieć złożoną, wieloczynnikową etiologię, a niektóre aspekty mechanizmów patofizjologicznych nadal wymagają wyjaśnienia⁴².

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#2 Trigeminal Neuralgia: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn
Trigeminal neuralgia (TN) causes episodes of intense facial pain that can disrupt your everyday activities. It typically happens when a blood vessel puts pressure on your trigeminal nerve near your brainstem. This nerve provides sensation to your head and face. […] In general, pressure on or damage to your trigeminal nerve causes TN. Healthcare providers categorize trigeminal neuralgia based on the specific cause: […] Primary (classic) TN: This type happens when a blood vessel (usually the superior cerebellar artery) pushes on part of the trigeminal nerve root (nerve compression). Its the most common cause. […] Secondary TN happens when another condition damages or affects your trigeminal nerve, like multiple sclerosis (MS), a tumor or arteriovenous malformation. […] Factors that may increase your risk of developing TN include: High blood pressure. Smoking. Aging. Female sex. Having a biological family history of TN.
#3 Trigeminal neuralgia | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/trigeminal-neuralgia/
In the vast majority of cases, trigeminal neuralgia is caused by compression of the trigeminal nerve. This is the largest nerve inside the skull, which transmits sensations of pain and touch from your face, teeth and mouth to your brain. […] This compression is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull. […] In rare cases, trigeminal neuralgia can occur as a result of damage to the trigeminal nerve, caused by an underlying condition such as multiple sclerosis (MS) or a tumour. […] Although the exact cause is not known, trigeminal neuralgia is often thought to be caused by compression of the trigeminal nerve or an underlying condition affecting this nerve. […] Evidence suggests that in up to 95% of cases, the cause of trigeminal neuralgia is pressure on the trigeminal nerve close to where it enters the brain stem (the lowest part of the brain that merges with the spinal cord), past the Gasserian ganglion.
#4
https://www.nhs.uk/conditions/trigeminal-neuralgia/causes/
There are 3 main types of trigeminal neuralgia: classical trigeminal neuralgia which is caused by pressure on the trigeminal nerve; this nerve provides sensation to the face […] classical trigeminal neuralgia is caused by pressure on the trigeminal nerve close to where it enters the brain stem. […] In most cases the pressure is caused by an artery or vein squashing (compressing) the trigeminal nerve. […] Secondary trigeminal neuralgia is the term used when trigeminal neuralgia is caused by another medical condition or problem, including: a tumour, a cyst a fluid-filled sac, arteriovenous malformation an abnormal tangle of arteries and veins, multiple sclerosis (MS) a long-term condition that affects the nervous system, facial injury, damage caused by surgery including dental surgery.
#5 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#6 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#7 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Although a questionable family clustering exists, trigeminal neuralgia (TN) is most likely multifactorial. […] Most cases of trigeminal neuralgia are idiopathic, but compression of the trigeminal roots by tumors or vascular anomalies may cause similar pain, as discussed in Pathophysiology. In one study, 64% of the compressing vessels were identified as an artery, most commonly the superior cerebellar (81%). Venous compression was identified in 36% of cases. […] Trigeminal neuralgia is divided into two categories: classic and symptomatic. The classic form, considered idiopathic, actually includes the cases that are due to a normal artery present in contact with the nerve, such as the superior cerebellar artery or even a primitive trigeminal artery. […] Symptomatic forms can have multiple origins. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons causing symptomatic trigeminal neuralgia. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant; lesions in the pons at the root entry zone of the trigeminal fibers have been demonstrated. These lesions may cause a similar pain syndrome as in trigeminal neuralgia.
#8 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#9 Trigeminal Neuralgia – Neurologic Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/neurologic-disorders/neuro-ophthalmologic-and-cranial-nerve-disorders/trigeminal-neuralgia
Trigeminal neuralgia is usually caused by […] Compression of the trigeminal nerve at its root by an aberrant loop of an intracranial artery (eg, anterior inferior cerebellar artery, ectatic basilar artery) […] Less often, a venous loop that compresses the 5th cranial (trigeminal) nerve at its root entry zone into the brain stem […] Other less common causes include compression by a tumor, an arteriovenous malformation, an aneurysm, and occasionally a multiple sclerosis plaque at the root entry zone (usually in younger patients), but these causes are usually distinguished by accompanying sensory loss and other deficits. […] The mechanism is unclear. One theory suggests that nerve compression causes local demyelination, which may result in ectopic impulse generation (ephaptic transmission) and/or disinhibition of central pain pathways involving the spinal trigeminal nucleus. […] Trigeminal neuralgia is usually caused by compression by an intracranial artery.
#10 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The trigeminal neuralgia etiology can be classified into idiopathic, classic, and secondary. […] Classic trigeminal neuralgia is associated with neurovascular compression in the trigeminal root entry zone, which causes nerve root atrophy or displacement. […] The etiology of TN and the underlying mechanisms of this condition are still poorly understood and based on the etiology, TN is classified into idiopathic TN, classic TN, and secondary TN. […] Classic TN is associated with neurovascular compression (NVC) in the trigeminal root entry zone, which causes nerve root atrophy or displacement. […] Several alterations have been described as a result of the vascular compression, including focal demyelination at the entry zone of the trigeminal nerve, atrophy or hypertrophy of peripheral axons, and damage to Schwann cells as well as to peripheral myelin.
#11 Trigeminal Neuralgia – Neurologic Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/neurologic-disorders/neuro-ophthalmologic-and-cranial-nerve-disorders/trigeminal-neuralgia
Trigeminal neuralgia is usually caused by […] Compression of the trigeminal nerve at its root by an aberrant loop of an intracranial artery (eg, anterior inferior cerebellar artery, ectatic basilar artery) […] Less often, a venous loop that compresses the 5th cranial (trigeminal) nerve at its root entry zone into the brain stem […] Other less common causes include compression by a tumor, an arteriovenous malformation, an aneurysm, and occasionally a multiple sclerosis plaque at the root entry zone (usually in younger patients), but these causes are usually distinguished by accompanying sensory loss and other deficits. […] The mechanism is unclear. One theory suggests that nerve compression causes local demyelination, which may result in ectopic impulse generation (ephaptic transmission) and/or disinhibition of central pain pathways involving the spinal trigeminal nucleus. […] Trigeminal neuralgia is usually caused by compression by an intracranial artery.
#12
https://www.nhs.uk/conditions/trigeminal-neuralgia/causes/
There are 3 main types of trigeminal neuralgia: classical trigeminal neuralgia which is caused by pressure on the trigeminal nerve; this nerve provides sensation to the face […] classical trigeminal neuralgia is caused by pressure on the trigeminal nerve close to where it enters the brain stem. […] In most cases the pressure is caused by an artery or vein squashing (compressing) the trigeminal nerve. […] Secondary trigeminal neuralgia is the term used when trigeminal neuralgia is caused by another medical condition or problem, including: a tumour, a cyst a fluid-filled sac, arteriovenous malformation an abnormal tangle of arteries and veins, multiple sclerosis (MS) a long-term condition that affects the nervous system, facial injury, damage caused by surgery including dental surgery.
#13 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#14
https://www.nhs.uk/conditions/trigeminal-neuralgia/causes/
There are 3 main types of trigeminal neuralgia: classical trigeminal neuralgia which is caused by pressure on the trigeminal nerve; this nerve provides sensation to the face […] classical trigeminal neuralgia is caused by pressure on the trigeminal nerve close to where it enters the brain stem. […] In most cases the pressure is caused by an artery or vein squashing (compressing) the trigeminal nerve. […] Secondary trigeminal neuralgia is the term used when trigeminal neuralgia is caused by another medical condition or problem, including: a tumour, a cyst a fluid-filled sac, arteriovenous malformation an abnormal tangle of arteries and veins, multiple sclerosis (MS) a long-term condition that affects the nervous system, facial injury, damage caused by surgery including dental surgery.
#15 Trigeminal neuralgia | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/trigeminal-neuralgia/
In most cases, this pressure seems to be caused by an artery or vein compressing the trigeminal nerve, although its not known why this happens. […] Other reasons why the trigeminal nerve can become compressed or damaged include: a tumour (a growth or lump), a cyst (fluid-filled sac), arteriovenous malformation (an abnormal tangle of arteries and veins), multiple sclerosis (MS) a long-term condition that affects the central nervous system (the brain and spinal cord).
#16 Trigeminal neuralgia – Wikipedia
https://en.wikipedia.org/wiki/Trigeminal_neuralgia
Believed to be due to problems with myelin of trigeminal nerve. […] The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve. […] This might occur due to nerve compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. […] It has been suggested that this compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve. […] Further causes, besides an aneurysm, multiple sclerosis or cerebellopontine angle tumor, include: a posterior fossa tumor, any other expanding lesion or even brainstem diseases from strokes. […] Trigeminal neuralgia is found in 34% of people with multiple sclerosis, according to data from seven studies. […] Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged, called Ramsay Hunt syndrome type 2. […] When there is no apparent structural cause, the syndrome is called idiopathic.
#17 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Trigeminal neuralgia is a painful neurological condition often described as a „lightning bolt” to the face. The most common etiology of trigeminal neuralgia is vascular compression of the nerve root, frequently by the superior cerebellar artery. Most cases of trigeminal neuralgia are secondary to compression of the trigeminal nerve root within a few millimeters of its entry into the pons. In 80% to 90% of these cases, the nerve root is compressed by an adjacent artery or a vein; the superior cerebellar artery is implicated in 75% to 80% of these circumstances. Other blood vessels known to compress the trigeminal nerve root and cause trigeminal neuralgia include the petrosal vein and the anterior inferior cerebellar or vertebral arteries. Trigeminal nerve compression may also be secondary to space-occupying lesions such as meningioma, acoustic neuroma, epidermoid cyst, arteriovenous malformation, or saccular aneurysm. Multiple sclerosis is a risk factor for developing trigeminal neuralgia and is the underlying etiology in approximately 2% to 4% of symptomatic patients secondary to demyelination of the trigeminal nerve nucleus.
#18 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Tumor-related causes of trigeminal neuralgia (most commonly in the cerebello-pontine angle) include acoustic neurinoma, chordoma at the level of the clivus, pontine glioma or glioblastoma, epidermoid, metastases, and lymphoma. Trigeminal neuralgia may result from paraneoplastic etiologies. […] Vascular causes include a pontine infarct and arteriovenous malformation or aneurysm in the vicinity. […] Inflammatory causes include multiple sclerosis (common), sarcoidosis, and Lyme disease neuropathy. […] Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks, and one atypical case followed tongue piercing. Another case report of trigeminal neuralgia was reported in a patient with spontaneous intracranial hypotension; both conditions resolved following surgical treatment of a cervical root sleeve dural defect.
#19 Trigeminal neuralgia | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/trigeminal-neuralgia/
In most cases, this pressure seems to be caused by an artery or vein compressing the trigeminal nerve, although its not known why this happens. […] Other reasons why the trigeminal nerve can become compressed or damaged include: a tumour (a growth or lump), a cyst (fluid-filled sac), arteriovenous malformation (an abnormal tangle of arteries and veins), multiple sclerosis (MS) a long-term condition that affects the central nervous system (the brain and spinal cord).
#20 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Tumor-related causes of trigeminal neuralgia (most commonly in the cerebello-pontine angle) include acoustic neurinoma, chordoma at the level of the clivus, pontine glioma or glioblastoma, epidermoid, metastases, and lymphoma. Trigeminal neuralgia may result from paraneoplastic etiologies. […] Vascular causes include a pontine infarct and arteriovenous malformation or aneurysm in the vicinity. […] Inflammatory causes include multiple sclerosis (common), sarcoidosis, and Lyme disease neuropathy. […] Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks, and one atypical case followed tongue piercing. Another case report of trigeminal neuralgia was reported in a patient with spontaneous intracranial hypotension; both conditions resolved following surgical treatment of a cervical root sleeve dural defect.
#21 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Although a questionable family clustering exists, trigeminal neuralgia (TN) is most likely multifactorial. […] Most cases of trigeminal neuralgia are idiopathic, but compression of the trigeminal roots by tumors or vascular anomalies may cause similar pain, as discussed in Pathophysiology. In one study, 64% of the compressing vessels were identified as an artery, most commonly the superior cerebellar (81%). Venous compression was identified in 36% of cases. […] Trigeminal neuralgia is divided into two categories: classic and symptomatic. The classic form, considered idiopathic, actually includes the cases that are due to a normal artery present in contact with the nerve, such as the superior cerebellar artery or even a primitive trigeminal artery. […] Symptomatic forms can have multiple origins. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons causing symptomatic trigeminal neuralgia. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant; lesions in the pons at the root entry zone of the trigeminal fibers have been demonstrated. These lesions may cause a similar pain syndrome as in trigeminal neuralgia.
#22 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Tumor-related causes of trigeminal neuralgia (most commonly in the cerebello-pontine angle) include acoustic neurinoma, chordoma at the level of the clivus, pontine glioma or glioblastoma, epidermoid, metastases, and lymphoma. Trigeminal neuralgia may result from paraneoplastic etiologies. […] Vascular causes include a pontine infarct and arteriovenous malformation or aneurysm in the vicinity. […] Inflammatory causes include multiple sclerosis (common), sarcoidosis, and Lyme disease neuropathy. […] Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks, and one atypical case followed tongue piercing. Another case report of trigeminal neuralgia was reported in a patient with spontaneous intracranial hypotension; both conditions resolved following surgical treatment of a cervical root sleeve dural defect.
#23 Trigeminal neuralgia – Wikipedia
https://en.wikipedia.org/wiki/Trigeminal_neuralgia
Believed to be due to problems with myelin of trigeminal nerve. […] The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve. […] This might occur due to nerve compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. […] It has been suggested that this compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve. […] Further causes, besides an aneurysm, multiple sclerosis or cerebellopontine angle tumor, include: a posterior fossa tumor, any other expanding lesion or even brainstem diseases from strokes. […] Trigeminal neuralgia is found in 34% of people with multiple sclerosis, according to data from seven studies. […] Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged, called Ramsay Hunt syndrome type 2. […] When there is no apparent structural cause, the syndrome is called idiopathic.
#24 Trigeminal neuralgia – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
Trigeminal neuralgia is caused by a disruption in the trigeminal nerve’s function. […] Contact between a blood vessel and the trigeminal nerve at the base of the brain often causes the pain. The blood vessel may be an artery or a vein. This contact puts pressure on the nerve and doesn’t allow it to function as usual. […] But while compression by a blood vessel is a common cause, there are many other potential causes. Multiple sclerosis or a similar condition that damages the myelin sheath protecting certain nerves can cause trigeminal neuralgia. A tumor pressing against the trigeminal nerve also can cause the condition. […] Some people may experience trigeminal neuralgia as a result of a stroke or facial trauma. An injury of the nerve due to surgery also can cause trigeminal neuralgia.
#25 Trigeminal Neuralgia – AANS
https://www.aans.org/patients/conditions-treatments/trigeminal-neuralgia/
Trigeminal neuralgia (TN) is sometimes described as the most excruciating pain known to humanity. […] The exact cause of TN is still unknown, but the pain associated with it represents an irritation of the nerve. Primary trigeminal neuralgia has been linked to the compression of the nerve, typically in the base of the head where the brain meets the spinal cord. This is usually due to contact between a healthy artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire. Secondary TN is caused by pressure on the nerve from a tumor, MS, a cyst, facial injury or another medical condition that damages the myelin sheaths.
#26 Trigeminal Neuralgia > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/trigeminal-neuralgia
Trigeminal neuralgia (TN), also called tic douloureux, is caused by a malfunction in the trigeminal nerve. This is a large bundle of fibers at the base of the brain that is responsible for sensation in the face. […] Although the exact cause of trigeminal neuralgia is not known, it can be caused by damage to the lining of the nerve. It may also be the result of an artery or a vein pushing against the trigeminal nerve. This can happen naturally as a person gets older, or it can also be caused by an injury or stroke. […] TN also can be caused by multiple sclerosis, or by a tumor or another brain abnormality. […] Having high blood pressure or smoking increases a person’s risk of developing TN. Multiple sclerosis is a well known risk factor for developing TN.
#27 Trigeminal Neuralgia: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/1145144-overview
Tumor-related causes of trigeminal neuralgia (most commonly in the cerebello-pontine angle) include acoustic neurinoma, chordoma at the level of the clivus, pontine glioma or glioblastoma, epidermoid, metastases, and lymphoma. Trigeminal neuralgia may result from paraneoplastic etiologies. […] Vascular causes include a pontine infarct and arteriovenous malformation or aneurysm in the vicinity. […] Inflammatory causes include multiple sclerosis (common), sarcoidosis, and Lyme disease neuropathy. […] Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks, and one atypical case followed tongue piercing. Another case report of trigeminal neuralgia was reported in a patient with spontaneous intracranial hypotension; both conditions resolved following surgical treatment of a cervical root sleeve dural defect.
#28 Trigeminal neuralgia – Wikipedia
https://en.wikipedia.org/wiki/Trigeminal_neuralgia
Believed to be due to problems with myelin of trigeminal nerve. […] The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve. […] This might occur due to nerve compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. […] It has been suggested that this compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve. […] Further causes, besides an aneurysm, multiple sclerosis or cerebellopontine angle tumor, include: a posterior fossa tumor, any other expanding lesion or even brainstem diseases from strokes. […] Trigeminal neuralgia is found in 34% of people with multiple sclerosis, according to data from seven studies. […] Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged, called Ramsay Hunt syndrome type 2. […] When there is no apparent structural cause, the syndrome is called idiopathic.
#29 Trigeminal Neuralgia | AAFP
https://www.aafp.org/pubs/afp/issues/2008/0501/p1291.html
Trigeminal neuralgia is an uncommon disorder characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. […] In classical trigeminal neuralgia, no cause of the symptoms can be identified other than vascular compression. […] Current theories regarding the cause of this demyelination center on vascular compression of the nerve root by aberrant or tortuous vessels. […] Most investigators now accept the theory that classical trigeminal neuralgia results from vascular compression of the nerve root. This leads to demyelination of the nerve and the generation of ectopic impulses that are spread ephaptically to precipitate the typical attack. […] Multiple other causes of trigeminal neuralgia have been described, including amyloid infiltration, arteriovenous malformations, bony compression, and small infarcts in the pons and medulla.
#30 Trigeminal Neuralgia: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn
Trigeminal neuralgia (TN) causes episodes of intense facial pain that can disrupt your everyday activities. It typically happens when a blood vessel puts pressure on your trigeminal nerve near your brainstem. This nerve provides sensation to your head and face. […] In general, pressure on or damage to your trigeminal nerve causes TN. Healthcare providers categorize trigeminal neuralgia based on the specific cause: […] Primary (classic) TN: This type happens when a blood vessel (usually the superior cerebellar artery) pushes on part of the trigeminal nerve root (nerve compression). Its the most common cause. […] Secondary TN happens when another condition damages or affects your trigeminal nerve, like multiple sclerosis (MS), a tumor or arteriovenous malformation. […] Factors that may increase your risk of developing TN include: High blood pressure. Smoking. Aging. Female sex. Having a biological family history of TN.
#31 Trigeminal Neuralgia (Tic Douloureux) | Stanford Health Care | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/trigeminal-neuralgia.html
Trigeminal neuralgia is usually caused by compression of the trigeminal nerve at the base of the brain. Most often, this is due to pressure from a blood vessel at the nerve root. A brain tumor can also compress the trigeminal nerve. […] Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Surgical injuries, stroke, or facial trauma may also be responsible for trigeminal neuralgia. […] Trigeminal neuralgia may run in families, possibly because family members share an inherited pattern of abnormal blood vessel formation.
#32 Trigeminal Neuralgia (Facial Pain) Causes and Treatments
https://www.webmd.com/pain-management/trigeminal-neuralgia
Some people are more likely to get trigeminal neuralgia than others: Women are more likely than men to get trigeminal neuralgia. The condition is more common in people older than 50. It may run in families, perhaps because of how blood vessels are formed in the brain. It may also be linked to high blood pressure.
#33 Trigeminal Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554486/
Demyelination is the presumptive primary pathophysiologic etiology of trigeminal neuralgia. Some theories describe demyelination secondary to vascular compression of the nerve root by tortuous or aberrant vessels. Other conditions, such as infiltrative amyloidosis, bony compression, arteriovenous malformation, and small infarcts in the medulla and pons, have been identified as etiologies of trigeminal neuralgia.
#34 Trigeminal Neuralgia | AAFP
https://www.aafp.org/pubs/afp/issues/2008/0501/p1291.html
Trigeminal neuralgia is an uncommon disorder characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. […] In classical trigeminal neuralgia, no cause of the symptoms can be identified other than vascular compression. […] Current theories regarding the cause of this demyelination center on vascular compression of the nerve root by aberrant or tortuous vessels. […] Most investigators now accept the theory that classical trigeminal neuralgia results from vascular compression of the nerve root. This leads to demyelination of the nerve and the generation of ectopic impulses that are spread ephaptically to precipitate the typical attack. […] Multiple other causes of trigeminal neuralgia have been described, including amyloid infiltration, arteriovenous malformations, bony compression, and small infarcts in the pons and medulla.
#35 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The ignition hypothesis, proposed by Devor et al., aims to correlate the structural changes with paroxysmal pain attacks, which are characteristic of the condition. […] There is accumulating evidence that voltage-gated sodium channels (VGSCs) play a crucial role in the generation of ectopic activity in trigeminal afferents. […] These findings are in accordance with clinical studies which have shown that patients with TN present the same profile of dysregulation in VGSCs. […] The alteration of a methionine in the position 136 to a valine (M136V) led to an increase in the peak current, without changing any biophysical properties of the channel. […] Thus, VGSCs have been considered the main target for pain control in TN.
#36 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The ignition hypothesis, proposed by Devor et al., aims to correlate the structural changes with paroxysmal pain attacks, which are characteristic of the condition. […] There is accumulating evidence that voltage-gated sodium channels (VGSCs) play a crucial role in the generation of ectopic activity in trigeminal afferents. […] These findings are in accordance with clinical studies which have shown that patients with TN present the same profile of dysregulation in VGSCs. […] The alteration of a methionine in the position 136 to a valine (M136V) led to an increase in the peak current, without changing any biophysical properties of the channel. […] Thus, VGSCs have been considered the main target for pain control in TN.
#37 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The ignition hypothesis, proposed by Devor et al., aims to correlate the structural changes with paroxysmal pain attacks, which are characteristic of the condition. […] There is accumulating evidence that voltage-gated sodium channels (VGSCs) play a crucial role in the generation of ectopic activity in trigeminal afferents. […] These findings are in accordance with clinical studies which have shown that patients with TN present the same profile of dysregulation in VGSCs. […] The alteration of a methionine in the position 136 to a valine (M136V) led to an increase in the peak current, without changing any biophysical properties of the channel. […] Thus, VGSCs have been considered the main target for pain control in TN.
#38 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The ignition hypothesis, proposed by Devor et al., aims to correlate the structural changes with paroxysmal pain attacks, which are characteristic of the condition. […] There is accumulating evidence that voltage-gated sodium channels (VGSCs) play a crucial role in the generation of ectopic activity in trigeminal afferents. […] These findings are in accordance with clinical studies which have shown that patients with TN present the same profile of dysregulation in VGSCs. […] The alteration of a methionine in the position 136 to a valine (M136V) led to an increase in the peak current, without changing any biophysical properties of the channel. […] Thus, VGSCs have been considered the main target for pain control in TN.
#39 Trigeminal neuralgia – Wikipedia
https://en.wikipedia.org/wiki/Trigeminal_neuralgia
Believed to be due to problems with myelin of trigeminal nerve. […] The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve. […] This might occur due to nerve compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. […] It has been suggested that this compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve. […] Further causes, besides an aneurysm, multiple sclerosis or cerebellopontine angle tumor, include: a posterior fossa tumor, any other expanding lesion or even brainstem diseases from strokes. […] Trigeminal neuralgia is found in 34% of people with multiple sclerosis, according to data from seven studies. […] Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged, called Ramsay Hunt syndrome type 2. […] When there is no apparent structural cause, the syndrome is called idiopathic.
#40 Trigeminal Neuralgia – Facial Pain AssociationIcon / Teal / print@1xicon-plusicon-minusicon-plusicon-minusicon-heart@1xicon-plane
https://www.facepain.org/understanding-facial-pain/diagnosis/trigeminal-neuralgia/
Idiopathic trigeminal neuralgia is trigeminal neuralgia with neither electrophysiological tests nor MRI showing significant abnormalities. […] Painful trigeminal neuropathy is facial pain in the distribution(s) of one or more branches of the trigeminal nerve caused by another disorder and indicative of neural damage (including herpes zoster, postherpetic neuralgia, and post-traumatic neuropathy).
#41 Trigeminal Neuralgia – Facial Pain AssociationIcon / Teal / print@1xicon-plusicon-minusicon-plusicon-minusicon-heart@1xicon-plane
https://www.facepain.org/understanding-facial-pain/diagnosis/trigeminal-neuralgia/
Idiopathic trigeminal neuralgia is trigeminal neuralgia with neither electrophysiological tests nor MRI showing significant abnormalities. […] Painful trigeminal neuropathy is facial pain in the distribution(s) of one or more branches of the trigeminal nerve caused by another disorder and indicative of neural damage (including herpes zoster, postherpetic neuralgia, and post-traumatic neuropathy).
#42 Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
https://pmc.ncbi.nlm.nih.gov/articles/PMC6985973/
The trigeminal neuralgia etiology can be classified into idiopathic, classic, and secondary. […] Classic trigeminal neuralgia is associated with neurovascular compression in the trigeminal root entry zone, which causes nerve root atrophy or displacement. […] The etiology of TN and the underlying mechanisms of this condition are still poorly understood and based on the etiology, TN is classified into idiopathic TN, classic TN, and secondary TN. […] Classic TN is associated with neurovascular compression (NVC) in the trigeminal root entry zone, which causes nerve root atrophy or displacement. […] Several alterations have been described as a result of the vascular compression, including focal demyelination at the entry zone of the trigeminal nerve, atrophy or hypertrophy of peripheral axons, and damage to Schwann cells as well as to peripheral myelin.