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三叉神経痛症状を呈した高齢者に発見された小脳橋角部の類上皮腫の２例
中川, 紗百合;新井, 絵理;松下, 貴惠;山野, 茂;松下, 和裕;渡邊, 裕;山崎, 裕
Permalink : http://hdl.handle.net/2115/82763
KEYWORDS : 三叉神経痛;舌痛;小脳橋角部;類上皮腫;カルバマゼピン;Cerebellopontine angle;Trigeminal neuralgia;Tongue pain;Epithelioid tumor;Carbamazepine
Abstract
今回，舌痛や上顎の痛みを訴えて当科受診した高齢女性に対し， 三叉神経痛を疑いカルバマゼピンを投与し，概ね痛みのコントロールが得られた．そこで中枢性の原因精査のため脳神経外科に対診したところ，同科のMRIにて小脳橋角部の類上皮腫が認められた2 症例を経験したので報告する．症例1 は81歳の女性．歯科治療後の左側下顎体部の間欠性の強い痛みを発症し，その後左側舌縁にもヒリヒリした痛みが出現した．前医で舌痛症と三叉神経痛との併発が疑われ，一旦症状は自然軽快したが，その後，舌痛は高度に強まり口内全体の灼熱感を伴ってきたため当科紹介受診した．症例2 は79歳女性．口腔カンジダ症の治療後に，左側上顎結節部の電撃様疼痛を自覚したため当科紹介受診となった．当科での精査では，2 症例とも三叉神経痛が疑われたため，カルバマゼピンが開始され一時著効を示した．しかしすぐに再燃傾向を示したが，増量により痛みのコントロールが可能になった．そこで中枢性の原因精査のため脳神経外科に対診した．両症例ともMR画像にて，小脳橋角部に類上皮腫が認められた．2 症例とも現在の症状や高齢による手術のリスクを考え薬物療法が行われた．
An elderly woman presented to our department complaining of tongue or maxillary pain. Trigeminal neuralgia was suspected and carbamazepine was administered. The pain was generally controlled. Herein, we report two cases in which epidermoid tumors of the cerebellopontine angle were detected using magnetic resonance imaging following consultation with neurosurgery to investigate the central cause. Case 1. An 81-year-old woman developed intense intermittent pain in the left mandibular body after dental treatment, followed by tingling pain in the left tongue margin. Her previous physician suspected a combination of glossodynia and trigeminal neuralgia, but her symptoms improved spontaneously. However, subsequently, the tongue pain became extremely severe and was accompanied by a burning sensation in the entire mouth. Therefore, the patient was referred to our department. Case 2. A 79-year-old woman was treated for oral candidiasis. She noticed shooting pain in the left maxillary tuberosity and was hence referred to our department. Upon close examination at our department, trigeminal neuralgia was suspected in both cases. Hence, carbamazepine was prescribed, which showed a temporary effect. Although the condition showed a tendency of relapsing shortly, the pain could be controlled by increasing carbamazepine dose. Hence, we consulted neurosurgery to investigate the central cause. In both cases, magnetic resonance images showed epithelioid tumors in the cerebellopontine angle. Both patients were elderly and were treated with pharmacotherapy considering their current symptoms and risk of surgery
An elderly woman presented to our department complaining of tongue or maxillary pain. Trigeminal neuralgia was suspected and carbamazepine was administered. The pain was generally controlled. Herein, we report two cases in which epidermoid tumors of the cerebellopontine angle were detected using magnetic resonance imaging following consultation with neurosurgery to investigate the central cause. Case 1. An 81-year-old woman developed intense intermittent pain in the left mandibular body after dental treatment, followed by tingling pain in the left tongue margin. Her previous physician suspected a combination of glossodynia and trigeminal neuralgia, but her symptoms improved spontaneously. However, subsequently, the tongue pain became extremely severe and was accompanied by a burning sensation in the entire mouth. Therefore, the patient was referred to our department. Case 2. A 79-year-old woman was treated for oral candidiasis. She noticed shooting pain in the left maxillary tuberosity and was hence referred to our department. Upon close examination at our department, trigeminal neuralgia was suspected in both cases. Hence, carbamazepine was prescribed, which showed a temporary effect. Although the condition showed a tendency of relapsing shortly, the pain could be controlled by increasing carbamazepine dose. Hence, we consulted neurosurgery to investigate the central cause. In both cases, magnetic resonance images showed epithelioid tumors in the cerebellopontine angle. Both patients were elderly and were treated with pharmacotherapy considering their current symptoms and risk of surgery
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