1、三叉神经痛与带状疱疹后神经痛(trigeminal neuralgia&post-herpetic neuralgia,TN&PHN),第一页，共七十九页。,Here is a piece of article extracted from health&disease information on July 13,2006,第二页，共七十九页。,Neuralgia,Neuralgia is sharp,severe,shooting pain along a nerve or group of nerves.The pain of neuralgia usually comes and go
2、es.Neuralgia can affect adults of any age,although some types are more common after middle age.Neuralgia is caused by irritation or damage to a nerve,although the cause of the irritation is often not known.The type of neuralgia that occurs depends upon which nerve is affected and the reason it is ir
3、ritated.Irritation can be caused by an infection,such as tooth decay,the herpes zoster virus(shingles),or nasal infections;eye strain;systemic diseases;arthritis;exposure to cold;a pinched nerve;injury;or even poor diet.,第三页，共七十九页。,Diagnosis,To diagnosis neuralgia,your doctor will take a complete me
4、dical history and perform a physical examination.He or she will suspect neuralgia based upon the location of your pain and its characteristic symptoms.Your doctor will look for an underlying cause of your symptoms.For example,if you have facial pain,your doctor will evaluate other possible causes su
5、ch as problems with the jaw,teeth,or sinuses.He or she will also check whether a tumor or aneurysm is putting pressure on a nerve.,第四页，共七十九页。,Therapies,Antiseizure drugs,such as carbamazepine and phenytoin,are often used to suppress pain associated with glossopharyngeal,trigeminal,and postherpetic n
6、euralgias because they slow down the nerve signals at certain nerve terminals.Postherpetic neuralgia can also be treated with antidepressants,topical pain relievers,transcutaneous electrical nerve stimulation(TENS),or a drug called capsaicin.In some cases,the nerve can be deadened with gamma rays,ra
7、dio frequency waves,or glycerol injections.The nerve can also be cut or permanently destroyed.If neuralgia is caused by an artery or tumor compressing the nerve,or a pinched nerve,surgery may be needed to free the nerve.Alternative treatments include B-complex vitamin therapy,acupuncture,and herbal
8、remedies that have been found to have anti-inflammatory effects.,第五页，共七十九页。,Self-care tips,Although there is no way to prevent neuralgia,you can take steps to avoid attacks if you know what triggers them.For example,if your pain is in the facial or mouth area,avoid very cold or very hot food and dri
9、nks,dont chew your food on the side that is painful,dont eat extremely hard or crunchy foods,avoid splashing your face with very hot or cold water when washing,and rinse your mouth with water after every meal instead of using a toothbrush.If you have shingles,seeking treatment as soon as possible ca
10、n reduce your risk of developing post-herpetic neuralgia.,第六页，共七十九页。,TN&PHN,三叉神经痛(trigeminal neuralgia,TN)与带状疱疹后神经痛(post-herpetic neuralgia,PHN)是较为常见的两种神经病理性疼痛疾病。二者同属于神经病理性疼痛，临床表现与治疗方案固有(gyu)相似之处；二者发病机理、疼痛表现又各有特点，因而治疗措施亦有所不同。,第七页，共七十九页。,TN&PHN 相 同 点,临床表现：均表现为自发痛(spontaneous pain)与诱发痛(evoked pain)；检查
11、可有扳机点(trigger points)疼痛范围内的皮肤痛觉过敏(hyperalgia)及触诱发痛(allodynia,又称痛觉超敏或痛觉异常)。治疗措施(cush)：均可采用抗癫痫药(anti-seizure drugs,抗惊厥药,anticonvulsants)、抗抑郁药(anti-depressive drugs)、阿片类镇痛药(opioids)、神经射频热凝毁损等治疗。,第八页，共七十九页。,TN&PHN 不 同 点,第九页，共七十九页。,一、三叉神经痛trigeminal neuralgia,TN,第十页，共七十九页。,三叉神经痛,三叉神经痛分为原发性、继发性三叉神经痛两种。原发性
12、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的患者，部分为邻近正常血管压迫所致。继发性三叉神经痛是指由于三叉神经节邻近组织病变所引起的疼痛症状。多数有神经系统体征。原因包括桥小脑(xiono)角、三叉神经根或半月神经节部位的肿瘤、血管畸形、动脉瘤、蛛网膜炎等异常组织压迫三叉神经节，导致神经细胞营养障碍，神经纤维脱髓鞘，异常高频放电，表现三叉神经分布区疼痛症状。,第十一页，共七十九页。,原发性三叉神经痛,原发性三叉神经痛病人的诊断可通过详细询问病人的病史、疼痛部位、疼痛性质等临床表现，另外，通过检查发现多数病人因长期吃饭受影响而全身情况较瘦弱。疼痛发作时表情(bioqn
13、g)痛苦，面部油腻，不愿讲话，即使在间歇期患者也不愿讲话或很少讲话。但病人神经系统检查正常，三叉神经各种感觉、运动及角膜反射，下颌反射均无明显的异常改变。部分患者因既往治疗造成颜面部局部痛觉略减退，此点应与继发性三叉神经痛引起的面部感觉减退相鉴别。影像学无异常改变。,第十二页，共七十九页。,三叉神经痛应具备(jbi)下述特征,性别与年龄(ninlng)：年龄(ninlng)多在40岁以上，以中、老年人为多。女性多于男性，约为32。疼痛部位：右侧多于左侧，疼痛由面部、口腔或下颌的某一点开始扩散到三叉神经某一支或多支，以第二支、第三支发病最为常见，第一支者少见。其疼痛范围绝对不超越面部中线，亦不超
14、过三叉神经分布区域。偶尔有双侧三叉神经痛者，占3%。疼痛性质：如倒割、针刺、撕裂、烧灼或电击样剧烈难忍的疼痛，甚至痛不欲生。,第十三页，共七十九页。,三叉神经痛应具备(jbi)下述特征,疼痛的规律：三叉神经痛的发作常无预兆，而疼痛发作一般有规律。每次疼痛发作时间由仅持续数秒到12分钟骤然停止。初期起病时发作次数较少，间歇期亦长，数分钟、数小时不等，随病情发展，发作逐渐频繁，间歇期逐渐缩短，疼痛亦逐渐加重而剧烈。夜晚(ywn)疼痛发作减少。间歇期无任何不适。诱发因素：说话、吃饭、洗脸、剃须、刷牙以及风吹等均可诱发疼痛发作，以致病人惶惶不可终日，精神萎靡不振，行动谨小慎微，甚至不敢洗脸、刷牙、进食
15、，说话也小心，惟恐引起发作。,第十四页，共七十九页。,扳机点：扳机点亦称“触发点”，常位于上唇、鼻翼、齿龈、口角、舌、眉等处。轻触或刺激扳机点可激发疼痛发作。表情和颜面部变化：发作时常突然停止说话、进食等活动，疼痛侧面部可呈现痉挛(jn lun)，即“痛性痉挛(jn lun)”，皱眉咬牙、张口掩目，或用手掌用力揉搓颜面以致局部皮肤粗糙、增厚、眉毛脱落、结膜充血、流泪及流涎。表情呈精神紧张、焦虑状态。神经系统检查：无异常，少数有面部感觉减退。,三叉神经痛应具备(jbi)下述特征,第十五页，共七十九页。,继发性三叉神经痛,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。出现(chx
16、in)类似于原发性三叉神经痛在颜面部疼痛发作的表现，但其疼痛程度较轻，疼痛发作的持续时间较长，或者呈持续性痛，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，少数可发现三叉神经损害区域和原发性疾病表现的特点。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。,第十六页，共七十九页。,鉴别(jinbi)诊断,应进一步询问病史，尤其询问既往是否有高血压、糖尿病史，及进行全面神经系统检查(jinch)，必要时包括腰穿、颅底和内听道摄片、颅脑CT、MRI等检查(jinch)，以与继发性三叉神经痛鉴别。有时继发性三叉神经痛的发作情况与原发性三叉神经痛极为相似，若不注意继发病变早期的细微表现，很容易被误诊。,第十七页，共七十九页。,鉴别(jinbi)诊断,引起颜面部疼痛的疾病很多，无论颅外疾病还是颅内疾病，血管疾病还是神经疾病都可使颜面部疼痛。各种(zhn)引起颜面部疼痛的疾病有其共同点，就是都能使颜面部具有与三叉神经痛类似的疼痛但各有其自己的特点，如颅外疾病多有局部的改变及压痛点，颅内局部多有眼底的变化及其他颅神经的改变等。在作鉴别诊断时，应注意病史，仔
