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By Prodyut Das

Trigeminal Neuralgia Causes

by Prodyut Das
(New Delhi, India)

Trigeminal neuralgia (TN) probably results from the focal demyelination of the trigeminal nerve or ganglia. Symptomatic causes include intrinsic and extrinsic tumors near the gasserian ganglia and multiple sclerosis (MS) plaques located around the root entry zone of the trigeminal nerve. In the past, dental disease or dental procedures were thought to occasionally cause TN. However, the delineation of the syndrome of pretrigeminal neuralgia, which mimics dental illness, casts doubt on whether dental procedures can ever cause TN. Most cases of so-called idiopathic TN may be due to pulsations of an aberrant vascular loop on the trigeminal nerve. These pulsations induce a series of neural events that result in changes in wide dynamic range neurons in the trigeminal nucleus caudalis. Trigeminal neuralgia may be symptomatic of disorders which affect the nerve root or its entry zone.

Root or root entry zone compression

arterial vessels often abut and sometimes clearly indent the trigeminal nerve root at the entry zone at the pons, causing ephaptic transmission (short circuit).

tumours of the cerebello-pontine angle lying against the V nerve roots, e.g. meningioma, epidermoid cyst, frequently present with trigeminal neuralgia pain.

Demyelination
such a lesion in the pons should be considered in the young person with trigeminal neuralgia. Trigger spots are rare. Remission occur infrequently and the response to drug treatment is poor.

In some cases the cause remains unexplained, as do the long period of remissions.


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