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

pre-trigeminal neuralgia

北海道歯学会

北海道歯学雑誌

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.