The Fifth Cranial Nerve in Headaches J
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Hereditary Hypertrophic Neuropathy Combining Features of Tic Douloureux, Charcot- Marie-Tooth Disease, and Deafness
Hereditary hypertrophic neuropathy combining features of tic douloureux, Charcot- Marie-Tooth disease, and deafness Hereditary hypertrophic sensorimotor poly- neuropathy combining the features of Charcot- Marie-Tooth disease, trigeminal neuralgia, and Robert P. Cruse, D.O. deafness occurred through four generations of John P. Conomy, M.D. a family originating in Haywood County, North Asa J. Wilbourn, M.D. Carolina. Fourteen individuals had pes cavus, Maurice R. Hanson, M.D. distal muscle atrophy, depressed or absent mus- cle stretch reflexes, cutaneous sensory deficits, Department of Neurology and defective proprioception. Six family mem- bers had recurrent, lancinating, trigeminal pain, and seven were deaf. The family was brought under scrutiny when the propositus, a 60-year-old woman, was examined for treat- ment of tic douloureux. Neurologic informa- tion was ultimately obtained regarding 52 family members. No history of consanguinity could be ascertained within this kinship. The genealogy of the family we studied is presented in Figure 1. In addition to clinical neurologic examinations, electromyographic and nerve conduction stud- ies were obtained on those individuals indicated in the genealogy diagram. Audiometric studies were obtained when there was clinical indication of defective hearing. Quantitative cutaneous sensory testing was obtained in the propositus. 107 Downloaded from www.ccjm.org on October 1, 2021. For personal use only. All other uses require permission. 108 Cleveland Clinic Quarterly Vol. 44, No. 3 ' • CMT a TIC Deaf CMT He Examined MS f Died O Not Affected 0 D led before age onset (O Multiple normal d1 ond j si be. -1—i Two Marriages —Indicates number of slbs. -
Nerves of the Orbit Optic Nerve the Optic Nerve Enters the Orbit from the Middle Cranial Fossa by Passing Through the Optic Canal
human anatomy 2016 lecture fourteen Dr meethak ali ahmed neurosurgeon Nerves of the Orbit Optic Nerve The optic nerve enters the orbit from the middle cranial fossa by passing through the optic canal . It is accompanied by the ophthalmic artery, which lies on its lower lateral side. The nerve is surrounded by sheath of pia mater, arachnoid mater, and dura mater. It runs forward and laterally within the cone of the recti muscles and pierces the sclera at a point medial to the posterior pole of the eyeball. Here, the meninges fuse with the sclera so that the subarachnoid space with its contained cerebrospinal fluid extends forward from the middle cranial fossa, around the optic nerve, and through the optic canal, as far as the eyeball. A rise in pressure of the cerebrospinal fluid within the cranial cavity therefore is transmitted to theback of the eyeball. Lacrimal Nerve The lacrimal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward along the upper border of the lateral rectus muscle . It is joined by a branch of the zygomaticotemporal nerve, whi(parasympathetic secretomotor fibers). The lacrimal nerve ends by supplying the skin of the lateral part of the upper lid. Frontal Nerve The frontal nerve arises from the ophthalmic division of the trigeminal nerve. It enters the orbit through the upper part of the superior orbital fissure and passes forward on the upper surface of the levator palpebrae superioris beneath the roof of the orbit . -
Cranial Nerve Palsy
Cranial Nerve Palsy What is a cranial nerve? Cranial nerves are nerves that lead directly from the brain to parts of our head, face, and trunk. There are 12 pairs of cranial nerves and some are involved in special senses (sight, smell, hearing, taste, feeling) while others control muscles and glands. Which cranial nerves pertain to the eyes? The second cranial nerve is called the optic nerve. It sends visual information from the eye to the brain. The third cranial nerve is called the oculomotor nerve. It is involved with eye movement, eyelid movement, and the function of the pupil and lens inside the eye. The fourth cranial nerve is called the trochlear nerve and the sixth cranial nerve is called the abducens nerve. They each innervate an eye muscle involved in eye movement. The fifth cranial nerve is called the trigeminal nerve. It provides facial touch sensation (including sensation on the eye). What is a cranial nerve palsy? A palsy is a lack of function of a nerve. A cranial nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. In the case of a cranial nerve that has multiple functions (such as the oculomotor nerve), it is possible for a palsy to affect all of the various functions or only some of the functions of that nerve. What are some causes of a cranial nerve palsy? A cranial nerve palsy can occur due to a variety of causes. It can be congenital (present at birth), traumatic, or due to blood vessel disease (hypertension, diabetes, strokes, aneurysms, etc). -
Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: a Case Report
E CASE REPORT Maxillary Nerve-Mediated Postseptoplasty Nasal Allodynia: A Case Report Shikha Sharma, MD, PhD,* Wilson Ly, MD, PharmD,* and Xiaobing Yu, MD*† Endoscopic nasal septoplasty is a commonly performed otolaryngology procedure, not known to cause persistent postsurgical pain or hypersensitivity. Here, we discuss a unique case of persis- tent nasal pain that developed after a primary endoscopic septoplasty, which then progressed to marked mechanical and thermal allodynia following a revision septoplasty. Pain symptoms were found to be mediated by the maxillary division of the trigeminal nerve and resolved after percuta- neous radiofrequency ablation (RFA) of bilateral maxillary nerves. To the best of our knowledge, this is the first report of maxillary nerve–mediated nasal allodynia after septoplasty. (A&A Practice. 2020;14:e01356.) GLOSSARY CT = computed tomography; FR = foramen rotundum; HIPAA = Health Insurance Portability and Accountability Act; ION = infraorbital nerve; LPP = lateral pterygoid plate; MRI = magnetic reso- nance imaging; RFA = radiofrequency ablation; SPG = sphenopalatine ganglion; US = ultrasound ndoscopic nasal septoplasty is a common otolaryn- septoplasty for chronic nasal obstruction with resection of gology procedure with rare incidence of postsurgical the cartilage inferiorly and posteriorly in 2010. Before this Ecomplications. Minor complications include epistaxis, surgery, the patient only occasionally experienced mild septal hematoma, septal perforation, cerebrospinal fluid leak, headaches. However, his postoperative course was compli- and persistent obstruction.1 Numbness or hypoesthesia of the cated by significant pain requiring high-dose opioids. After anterior palate, secondary to injury to the nasopalatine nerve, discharge, patient continued to have persistent deep, “ach- has been reported, but is usually rare and temporary, resolv- ing” nasal pain which radiated toward bilateral forehead ing over weeks to months.2 Acute postoperative pain is also and incisors. -
Neurophysiological Aspects of the Trigeminal Sensory System: an Update
Rev. Neurosci. 2018; 29(2): 115–123 Frederic Van der Cruyssen* and Constantinus Politis Neurophysiological aspects of the trigeminal sensory system: an update https://doi.org/10.1515/revneuro-2017-0044 Keywords: infraorbital; mandibular; neurophysiology; Received June 21, 2017; accepted July 20, 2017; previously published ophthalmic nerve; oral somatosensory functioning; online November 8, 2017 trigeminal sensory system. Abstract: The trigeminal system is one of the most complex cranial nerve systems of the human body. Research on it has vastly grown in recent years and concentrated more and more on molecular mechanisms and pathophysiology, Introduction but thorough reviews on this topic are lacking, certainly Knowledge about physiological aspects of the trigeminal on the normal physiology of the trigeminal sensory system. system today is largely based on animal models (Akerman Here we review the current literature on neurophysiology and Goadsby, 2015; Herta et al., 2017), cadaver studies of the trigeminal nerve from peripheral receptors up to its (Ezure et al., 2001; Williams et al., 2003) or extrapola- central projections toward the somatosensory cortex. We tions from peripheral nerve functioning. Human studies focus on the most recent scientific discoveries and describe are frequently limited to pathophysiology and lack proper historical relevant research to substantiate further. One study designs (Tanaka and Zhao, 2016; Goadsby et al., chapter on new insights of the pathophysiology of pain 2017). Neurophysiological research in this area is difficult at the level of the trigeminal system is added. A database due to the invasive character of most neurophysiological search of Medline, Embase and Cochrane was conducted tests, the small caliber of fibers, high density of receptors, with the search terms ‘animal study’, ‘neurophysiology’, cross-connections between different cranial nerves, dif- ‘trigeminal’, ‘oral’ and ‘sensory’. -
Simple Ways to Dissect Ciliary Ganglion for Orbital Anatomical Education
OkajimasDetection Folia Anat. of ciliary Jpn., ganglion94(3): 119–124, for orbit November, anatomy 2017119 Simple ways to dissect ciliary ganglion for orbital anatomical education By Ming ZHOU, Ryoji SUZUKI, Hideo AKASHI, Akimitsu ISHIZAWA, Yoshinori KANATSU, Kodai FUNAKOSHI, Hiroshi ABE Department of Anatomy, Akita University Graduate School of Medicine, Akita, 010-8543 Japan –Received for Publication, September 21, 2017– Key Words: ciliary ganglion, orbit, human anatomy, anatomical education Summary: In the case of anatomical dissection as part of medical education, it is difficult for medical students to find the ciliary ganglion (CG) since it is small and located deeply in the orbit between the optic nerve and the lateral rectus muscle and embedded in the orbital fat. Here, we would like to introduce simple ways to find the CG by 1): tracing the sensory and parasympathetic roots to find the CG from the superior direction above the orbit, 2): transecting and retracting the lateral rectus muscle to visualize the CG from the lateral direction of the orbit, and 3): taking out whole orbital structures first and dissecting to observe the CG. The advantages and disadvantages of these methods are discussed from the standpoint of decreased laboratory time and students as beginners at orbital anatomy. Introduction dissection course for the first time and with limited time. In addition, there are few clear pictures in anatomical The ciliary ganglion (CG) is one of the four para- textbooks showing the morphology of the CG. There are sympathetic ganglia in the head and neck region located some scientific articles concerning how to visualize the behind the eyeball between the optic nerve and the lateral CG, but they are mostly based on the clinical approaches rectus muscle in the apex of the orbit (Siessere et al., rather than based on the anatomical procedure for medical 2008). -
Molecular Diagnostics of Charcot-Marie-Tooth Disease and Related Peripheral Neuropathies
17_Lupski 3/30/06 1:47 PM Page 243 NeuroMolecular Medicine Copyright © 2006 Humana Press Inc. All rights of any nature whatsoever reserved. ISSN0895-8696/06/08:243–254/$30.00 doi: 10.1385/NMM:8:1:243 REVIEW ARTICLE Molecular Diagnostics of Charcot-Marie-Tooth Disease and Related Peripheral Neuropathies Kinga Szigeti,1 Eva Nelis,2,3 and James R. Lupski*,1,4 1Departments of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; 2Molecular Genetics, Flanders Interuniversity Institute for Biotechnology, Institute Born-Bunge, University of Antwerp, Antwerpen, Belgium; 3Laboratory of Neurogenetics, Institute Born-Borge, University of Antwerp, Antwerpen, Belgium; and 4Pediatrics, Baylor College of Medicine, and Texas Children Hospital, Houston, TX 77030 Received January 10, 2006; Revised January 13, 2006; Accepted January 13, 2006 Abstract DNAdiagnostics plays an important role in the characterization and management of patients manifesting inherited peripheral neuropathies. We describe the clinical integration of molecular diagnostics with medical history, physical examination, and electrophysiological studies. Mole- cular testing can help establish a secure diagnosis, enable genetic counseling regarding recurrence risk, potentially provide prognostic information, and in the near future may be important for the choice of therapies. doi: 10.1385/NMM:8:1:243 Index Entries:Molecular diagnostics; Charcot-Marie-Tooth disease; CMT; hereditary neuropathy with liability to pressure palsies; HNPP; Dejerine-Sottas neuropathy; DSN; congenital hypomyelinating neuropathy; CHN; CMT1A duplication; HNPP deletion. Introduction genetic testing, one needs to be familiar with the diagnostic tests available, choose the appropriate Molecular genetic diagnosis has become an inte- patients for testing, and utilize the diagnostic tools gral part of the evaluation of patients with hered- in a logical fashion to optimize the use of resources. -
Extracranial Course of Cranial Nerves
Extracranial course of cranial nerves Oculomotor, Trochlear, Abducent, Trigeminal, Facial and Accessory nerves Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Dr. Heba Kalbouneh Brainstem Mid brain Pons Medulla Pons Inferior view Facial nerve Anatomically, the course of the facial nerve can be divided into two parts: Motor: Innervates the muscles of facial Intracranial – the course of the nerve through expression, the posterior belly of the the cranial cavity, and the cranium itself. digastric, the stylohyoid and the stapedius Extracranial – the course of the nerve outside muscles. the cranium, through the face and neck. General Sensory: A small area around the concha of the auricle, EAM Special Sensory: Provides special taste sensation to the anterior 2/3 of the tongue. Parasympathetic: Supplies many of the glands of the head and neck, including: 1- Submandibular and sublingual salivary glands (via the submandibular ganglion/ chorda tympani) 2- Nasal, palatine and pharyngeal mucous glands (via the pterygopalatine ganglion/ greater petrosal) 3- Lacrimal glands (via the pterygopalatine ganglion/ greater petrosal) Dr. Heba Kalbouneh Intracranial course The nerve arises in the pons. It begins as two roots; a large motor root, and a small sensory root The two roots travel through the internal acoustic meatus. Pons Here, they are in very close proximity to the inner ear. 7th (motor) 8th Note: The part of the facial nerve that runs between the motor root of facial and vestibulocochlear nerve is sometimes Kalbouneh known as the nervus intermedius It contains the sensory and parasympathetic Heba fibers of the facial nerve Dr. Dr. Still within the temporal bone, the roots leave the internal acoustic meatus, and enter into the facial canal. -
The Mandibular Nerve - Vc Or VIII by Prof
The Mandibular Nerve - Vc or VIII by Prof. Dr. Imran Qureshi The Mandibular nerve is the third and largest division of the trigeminal nerve. It is a mixed nerve. Its sensory root emerges from the posterior region of the semilunar ganglion and is joined by the motor root of the trigeminal nerve. These two nerve bundles leave the cranial cavity through the foramen ovale and unite immediately to form the trunk of the mixed mandibular nerve that passes into the infratemporal fossa. Here, it runs anterior to the middle meningeal artery and is sandwiched between the superior head of the lateral pterygoid and tensor veli palatini muscles. After a short course during which a meningeal branch to the dura mater, and the nerve to part of the medial pterygoid muscle (and the tensor tympani and tensor veli palatini muscles) are given off, the mandibular trunk divides into a smaller anterior and a larger posterior division. The anterior division receives most of the fibres from the motor root and distributes them to the other muscles of mastication i.e. the lateral pterygoid, medial pterygoid, temporalis and masseter muscles. The nerve to masseter and two deep temporal nerves (anterior and posterior) pass laterally above the medial pterygoid. The nerve to the masseter continues outward through the mandibular notch, while the deep temporal nerves turn upward deep to temporalis for its supply. The sensory fibres that it receives are distributed as the buccal nerve. The 1 | P a g e buccal nerve passes between the medial and lateral pterygoids and passes downward and forward to emerge from under cover of the masseter with the buccal artery. -
Morphometry and Morphology of Foramen Petrosum in Indian Population
Basic Sciences of Medicine 2020, 9(1): 8-9 DOI: 10.5923/j.medicine.20200901.02 Morphometry and Morphology of Foramen Petrosum in Indian Population Rajani Singh1,*, Nand Kishore Gupta1, Raj Kumar2 1Department of Anatomy, Uttar Pradesh University of Medical Sciences Saifai 206130 Etawah UP India 2Department of Neurosugery Uttar Pradesh University of Medical Sciences Saifai 206130 Etawah UP India Abstract Greater wing of sphenoid contains three constant foramina, Foramen ovale, foramen rotundum and foramen spinosum. The presence of foramen Vesalius and foramen petrosum are inconsistent. Normally foramen ovale transmits mandibular nerve, accessory meningeal artery, lesser petrosal nerve and emissary vein. When foramen petrosum is present, lesser petrosal nerve passes through petrosal foramen instead of foramen ovale. Lesser petrosal nerve distribute postganglionic fibers from otic ganglion to parotid gland. In absence of knowledge of petrosal foramen transmitting lesser petrosal nerve, the clinician may damage the nerve during skull base surgery creating complications like hyperemia of face and profuse salivation from the parotid gland (following atropine administration), lacrimation (crocodile tears syndrome) and mucus nasal secretion. Considering clinical implications associated with petrosal foramen, the study was carried out. The aim of the study is to determine the prevalence of petrosal foramen in Indian Population and to bring out associated clinical significance. The study was conducted in the department of Anatomy UPUMS Saifai Etawah Indian. 30 half skulls were observed for the presence of petrosal foramina and morphometry was also done. Literature search was carried out, our findings were compared with previous work and associated clinical implications were bought out. Keywords Petrosal foramen, Lesser petrosal nerve, Foramen ovale patients. -
Trigeminal Isolated Sensory Neuropathy (TISN) and FOSMN
Cruccu et al. BMC Neurology (2014) 14:248 DOI 10.1186/s12883-014-0248-2 RESEARCH ARTICLE Open Access Trigeminal isolated sensory neuropathy (TISN) and FOSMN syndrome: despite a dissimilar disease course do they share common pathophysiological mechanisms? Giorgio Cruccu1*, Elena M Pennisi2, Giovanni Antonini3, Antonella Biasiotta1, Giulia di Stefano1, Silvia La Cesa1, Caterina Leone1, Salvatore Raffa4, Claudia Sommer5 and Andrea Truini1 Abstract Background: Patients presenting with bilateral trigeminal hypoesthesia may go on to have trigeminal isolated sensory neuropathy, a benign, purely trigeminal neuropathy, or facial-onset sensory motor neuronopathy (FOSMN), a malignant life-threatening condition. No diagnostic criteria can yet differentiate the two conditions at their onset. Nor is it clear whether the two diseases are distinct entities or share common pathophysiological mechanisms. Methods: Seeking pathophysiological and diagnostic information to distinguish these two conditions at their onset, in this neurophysiological and morphometric study we neurophysiologically assessed function in myelinated and unmyelinated fibres and histologically examined supraorbital nerve biopsy specimens with optic and electron microscopy in 13 consecutive patients with recent onset trigeminal hypoesthesia and pain. Results: The disease course distinctly differed in the 13 patients. During a mean 10 year follow-up whereas in eight patients the disease remained relatively stable, in the other five it progressed to possibly life-threatening motor disturbances and extra-trigeminal spread. From two to six years elapsed between the first sensory symptoms and the onset of motor disorders. In patients with trigeminal isolated sensory neuropathy (TISN) and in those with FOSMN neurophysiological and histological examination documented a neuronopathy manifesting with trigeminal nerve damage selectively affecting myelinated fibres, but sparing the Ia-fibre-mediated proprioceptive reflex. -
Trigeminal Nerve Block
Trigeminal Nerve Block Why use this treatment? This procedure is used for trigeminal neuralgia, described by many patients as one of the most painful afflictions known. TN sufferers experience sudden attacks of pain that are typically brief, but severe. TN pain occurs on only one side, involving the upper, middle and/or lower portions of the face. Attacks may come on without warning or be triggered by specific light stimulation in the affected area of the face. Common triggers include touch, talking, eating, drinking, chewing, tooth brushing, hair combing, water from a shower and even kissing. There are a number of causes for trigeminal neuralgia, including pressure from blood vessels on the trigeminal nerve, multiple sclerosis, brain tumors, or injury to the nerve from head trauma, dental or sinus trauma or from failed procedures that were intended to treat the neuralgia. TN pain after traumatic injury is usually constant aching or burning, but can also get worse with exposure to wind or cold. How does a trigeminal nerve block work? A trigeminal nerve block delivers steroids and/or local anesthetic directly into the space around the trigeminal nerve root. The area is bathed in the medicine. The injection is given to reduce inflammation and provide pain relief for several days to several months. How is the procedure done? You will be placed on an x-ray table and your skin will be cleansed and prepared. This procedure is performed under local anesthetic with light IV sedation. A needle is inserted into the skin beside the mouth, and directed through an opening at the base of the skull.