|
|
Hokkaido University Collection of Scholarly and Academic Papers >
Societies >
北海道歯学雑誌 >
第44巻 >
当初は舌痛症が疑われたが，長期経過の後にガンマナイフが奏功した高齢女性の典型的三叉神経痛の１例
| Title: | 当初は舌痛症が疑われたが，長期経過の後にガンマナイフが奏功した高齢女性の典型的三叉神経痛の１例 |
| Other Titles: | Typical trigeminal neuralgia mimicking burning mouth syndrome successfully treated using gamma knife surgery: A case report |
| Authors: | 松田, 捺美1 Browse this author | | 平良, 賢周2 Browse this author | | 新井, 絵理3 Browse this author | | 尾崎, 公哉4 Browse this author →KAKEN DB | | 山野, 茂5 Browse this author →KAKEN DB | | 渡邊, 裕6 Browse this author →KAKEN DB | | 山崎, 裕7 Browse this author →KAKEN DB |
| Authors(alt): | Matsuda, Nami1 | | Taira, Kenshu2 | | Arai, Eri3 | | Ozaki, Kimiya4 | | Yamano, Sigeru5 | | Watanabe, Yutaka6 | | Yamazaki, Yutaka7 |
| Keywords: | 前三叉神経痛 | | 三叉神経痛 | | 舌痛症 | | ガンマナイフ | | 高齢者 | | pre-trigeminal neuralgia | | trigeminal neuralgia | | burning mouth syndrome | | gamma knife | | older adults |
| Issue Date: | 15-Sep-2023 |
| Publisher: | 北海道歯学会 |
| Journal Title: | 北海道歯学雑誌 |
| Volume: | 44 |
| Start Page: | 107 |
| End Page: | 112 |
| Abstract: | 我々は当初，舌痛症が疑われたが再燃を繰り返すうちに神経痛様の症状を呈するようになり，三叉神経痛と診断され，最終的にはガンマナイフが施行された症例を経験したので報告する．
患者は76歳女性で，初診時，舌の痛みは安静時の痛みで，左舌縁を触診するとかえって痛みは軽快した．舌痛に対してラフチジンが著効したが，再燃を繰り返した．7 年後，会話の始めに，左下顎全体に走行する発作性の鈍痛が出現するようになった．前三叉神経痛（Pretrigeminal neuralgia）の可能性を考慮し，カルバマゼピンを100 mg/日から投与開始した．これにより一時は痛みが完全に消退したが，数か月後には再燃したため，三叉神経痛を疑い脳神経外科に対診した．同科のMR画像で左三叉神経起始部を動脈が圧迫する所見が認められ，臨床症状，カルバマゼピンの効果から，典型的三叉神経痛と診断された．痛みはカルバマゼピンで一時的には良好にコントロールされたが，4年後には400mg/日の投与でもコントロール困難になった．87歳と高齢であったため，手術の適応はなくガンマナイフが施行された．その後約2年経過した現在，合併症はなくカルバマゼピン200 mgの服用下で痛みは良好にコントロールされている． | | We describe a patient with suspected burning mouth syndrome, who experienced repeated flare-ups and subsequently developed neuralgia-like symptoms, which led to diagnosis of trigeminal neuralgia. The patient eventually underwent gamma knife surgery.
A 76-year-old woman underwent physical examination, which showed tongue pain at rest; pain was less severe upon palpation of the left lingual border. Administration of raftidine led to remarkable improvement in her tongue pain; however, she had recurrent flare-ups. She developed paroxysmal dull pain that radiated across the entire left mandible at the onset of conversations, 7 years later and received carbamazepine (100 mg) for suspected pre-trigeminal neuralgia. Her pain disappeared completely temporarily; however, she experienced flare-ups a few months later. She consulted a neurosurgeon for a high index of clinical suspicion for trigeminal neuralgia. Based on MRI findings, which showed arterial compression of the left trigeminal nerve origin, clinical sympt oms, and the response to carbamazepine, we diagnosed trigeminal neuralgia. The pain was temporarily well controlled with carbamazepine therapy; however, pain persisted even with carbamazepine administration (400mg a day), 4 years later. Surgery was contraindicated owing to her advanced age (87years), and she underwent gamma knife surgery. The patient has shown no complications, and her pain is well controlled with carbamazepine (200mg), 2years postoperatively. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/90523 |
| Appears in Collections: | 北海道歯学雑誌 > 第44巻
|
|
