Atypical trigeminal neuralgia: case report
DOI:
https://doi.org/10.32385/rpmgf.v38i4.13137Keywords:
Trigeminal neuralgia, Meningioma, Carbamazepine, Case reportAbstract
Introduction: Trigeminal neuralgia is a chronic pain disorder characterized by a sudden onset of high-intensity pain triggered by some innocuous stimuli. However, in some cases, it may have atypical manifestations that make diagnosis more difficult.
Case description: This case reports a 77-year-old woman with dull pain in the upper right jaw that motivated multiple visits to health institutions. The patient underwent several courses of antibiotics and a tooth extraction due to suspicion of dental pathology. Subsequently, the pain evolved to a typical pattern of trigeminal neuralgia and this diagnosis was established. Pain management with carbamazepine was started and the study of secondary causes was initiated resulting in the identification of a meningioma in the right trigeminal path.
Comment: The atypical manifestations of trigeminal neuralgia can lead to a misdiagnosis of this pathology and for this reason a high clinical suspicion is important. The symptomatic therapy should be initiated at the time of the diagnosis and an investigation of secondary causes should be performed.
Downloads
References
Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:g474.
Von Eckardstein KL, Keil M, Rohde V. Unnecessary dental procedures as a consequence of trigeminal neuralgia. Neurosurg Rev. 2015;38(2):355-60.
Cruccu G. Trigeminal neuralgia. Continuum. 2017;23(2):396-420.
MacDonald BK, Cockerell OC, Sander JW, Shorvon SD. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 2000;123(pt 4):665-76.
Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991;10(5-6):276-81.
Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia: a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014;54(10):1574-82.
Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27(1):89-95.
Olesen J. Headache Classification Committee of the International Headache Society (IHS), The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020;383(8):754-62.
Evans RW, Graff-Radford SB, Bassiur JP. Pretrigeminal neuralgia. Headache. 2005;45(3):242-4.
Fromm GH, Graff-Radford SB, Terrence CF, Sweet WH. Pre‐trigeminal neuralgia. Neurology. 1990;40(10):1493-5.
Wright E, Evans J. Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results. Cranio. 2014;32(3):193-8.
Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831-49.
Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia: diagnosis and treatment. Cephalalgia. 2017;37(7):648-57.
Wang N, Osswald M. Meningiomas: overview and new directions in therapy. Semin Neurol. 2018;38(1):112-20.
Marosi C, Hassler M, Roessler K, Reni M, Sant M, Mazza E, et al. Meningioma. Crit Rev Oncol Hematol. 2008;67(2):153-71.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Portuguese Journal of Family Medicine and General Practice

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.