Neuralgia Trigeminal

ʻO Trigeminal neuralgia (TN) kahi maʻi nerve. Hoʻokumu ia i kahi ʻeha a uila paha e like me ka ʻeha ma nā ʻāpana o ka maka.

ʻO kaʻeha o ka TN mai ka nerve trigeminal. Hāpai kēia nerve i nā manaʻo o ka hoʻopā a me ka ʻeha mai ka maka, nā maka, nā hewa, a me ka waha i ka lolo.

Hoʻokumu ʻia paha ke neuralgia Trigeminal e:

• Multiple sclerosis (MS) a i ʻole nā ​​maʻi ʻino e hōʻino i ka uhi pale ʻana o myelin o nā ʻalolo
• Kaomi ma ke aʻalolo trigeminal mai kahi kīʻaha koko a pehu paha
• Ka ʻeha i ke aʻalolo trigeminal, e like me ka trauma i ka maka a i ʻole ka ʻoki waha a sinus paha

ʻO ka pinepine, ʻaʻohe kumu kūpono i loaʻa. Hoʻololi pinepine ka TN i nā mākua ma mua o 50 mau makahiki, akā hiki ke hana i kēlā me kēia makahiki. Hoʻopili pinepine ʻia nā wahine ma mua o nā kāne. Ke pili ka TN i ka poʻe ʻōpio ma mua o 40, pili pinepine ia iā MS a i kahi tumo.

Pākuʻi ʻia paha nā ʻōuli i kekahi o kēia mau mea:

• ʻEhaʻeha loa, ʻoi loa e like me ka uila e like me ka uila ma hope o ka hala ʻana o nā kekona he 2 mau minuke, akā hiki ke hoʻomau.
• ʻO ka ʻeha ma ka ʻaoʻao wale o ka maka, pinepine a puni ka maka, pāpālina, a me ka ʻaoʻao haʻahaʻa o ka maka.
• ʻAʻohe maʻamau o ka nalo o ka naʻau a i ʻole ka neʻe ʻana o ka ʻāpana i hoʻopili ʻia o ka maka.
• Hoʻokū ʻia paha ka ʻeha e ka hoʻopā a me nā kani.

Hiki ke hoʻoulu ʻia nā hōʻeha hōʻeha o nā neuralgia trigeminal e nā hana maʻamau, i kēlā me kēia lā, e like me:

• Kamaʻilio
• Minoʻaka
• Palaki niho
• E naue ana
• Ke inu nei
• ʻAi ʻaina
• Hōʻike i ka mahana wela a me ke anuanu
• Hoʻopā i ka maka
• ʻO ka ʻumiʻumi
• Makani
• Ke noi nei i ka make-up

Hoʻopili ka ʻaoʻao ʻākau o ka maka i ka hapa nui. I kekahi mau hihia, hele ʻo TN i kāna iho.

ʻO ka lolo a me ka ʻōnaehana ʻōnaehana (neurologic) nīnau maʻamau ka maʻamau. Hana ʻia nā hoʻāʻo e nānā no ke kumu.

• Helu piha koko
• Ka helu sedimentation ʻErythrocyte (ESR)
• MRI o ke poʻo
• MRA (angiography) o ka lolo
• Ninaninau maka (e kāpae i ka maʻi intraocular)
  
• CT scan o ke poʻo (ʻaʻole hiki ke loaʻa iā MRI)
  
• ʻO ka ho'āʻo reflex Trigeminal (i nā manawa kakaikahi)

ʻO kāu kauka mālama mua, he neurologist, a i ʻole he loea ʻeha e pili paha i kāu mālama.

ʻO kekahi mau lāʻau e kōkua i ka hōʻemi ʻana i ka ʻeha a me ka helu o ka hoʻouka ʻana. Hoʻopili kēia mau lāʻau:

• ʻO nā lāʻau anti-seizure, e like me carbamazepine
• Hoʻomaha hoʻomaha kaʻiʻo, e like me baclofen
• Nā lāʻau antidepressants Tricyclic

Hana ʻia kahi ʻeha ʻeha pōkole ma o ke kaha ʻana, akā pili ʻia me ka makaʻu o nā pilikia. Kāhea ʻia kahi ʻoki ʻana he decompression microvascular (MVD) a i ʻole ke kaʻina hana Jannetta. I ka wā o ke kāpili ʻana, hoʻonoho ʻia kahi mea sponge-like ma waena o ke aʻalolo a me ke kīʻaha koko e kaomi ana i ke aʻalolo.

ʻO ke poloka nerve Trigeminal (injection) me kahi anesthetic kūloko a me ka steroid kahi koho lapaʻau maikaʻi loa e hōʻoluʻolu koke i ka ʻeha ʻoiai ke kali nei no ka hopena o nā lāʻau.

ʻO nā ʻenehana ʻē aʻe e pili ana i ka luku ʻana a ʻoki ʻana paha i nā ʻāpana o ke aʻa nerve trigeminal. Nā hana i hoʻohana ʻia e:

• Hoʻomaha abadiofrequency (hoʻohana wela wela pinepine)
• Ka pahu kui o ka glycerol a i ʻole ka waiʻona
• Pākuʻi micro Balloon
• Radiosurgery (hoʻohana i ka ikehu kiʻekiʻe)

Inā he tumo ke kumu o ka TN, hana ʻoki ʻia e wehe iā ia.

Ma muli o ke kumu o ka pilikia. Inā ʻaʻohe maʻi e hoʻokumu i ka pilikia, hiki i ka lapaʻau ke hāʻawi i kahi hoʻomaha.

I kekahi poʻe, lilo ka ʻeha mau a koʻikoʻi.

Komo pū nā pilikia:

• Nā hopena o nā lāʻau i hoʻohana ʻia e mālama iā TN
• Nā pilikia i hoʻokumu ʻia e nā kaʻina hana, e like me ka nalo ʻana o ka manaʻo i ka wahi i mālama ʻia
• ʻO ka pohō kaumaha mai ka ʻai ʻole ʻana e hōʻalo ai i ka hoʻonāukiuki ʻana i ka ʻeha
• Ke pale nei i nā poʻe ʻē aʻe inā ke kamaʻilio e hoʻonāukiuki i ka ʻeha
• Kaumaha, pepehi kanaka
• Nā pae kiʻekiʻe o ka hopohopo i ka wā o ka hoʻouka kaua koʻikoʻi

E kāhea aku i kāu lawelawe mālama ola inā loaʻa kāu mau ʻōuli o TN, a i ʻole e ʻoi aku ka maikaʻi o kāu hōʻailona TN.

Tic douloureux; Neuralgia Cranial; ʻEha ʻeha - trigeminal; ʻO neuralgia helehelena; Neuralgia Trifacial; ʻEha mau loa - trigeminal; Hoʻopiʻi Microvascular - trigeminal

• ʻŌnaehana ʻōnaehana waena a me ka ʻōnaehana ʻōnaehana peripheral

Bendtsen L, Zakrzewska JM, Heinskou TB, et al. ʻO ka holomua i ka hōʻoia ʻana, ka hoʻonohonoho ʻana, ka pathophysiology, a me ka mālama ʻana i ka neuralgia trigeminal. Lancet Neurol. 2020; 19 (9): 784-796. PMID: 32822636 pubmed.ncbi.nlm.nih.gov/32822636/.

ʻO Gonzales TS. ʻO kaʻeha o ka helehelena a me nā maʻi neuromuscular. I: Neville BW, Damm DD, Allen CM, Chi AC, eds. ʻ Pathlelo a me Maxillofacial Pathology. ʻEhā ed. St Louis, MO: Elsevier; 2016: chap 18.

ʻO Stettler BA. Nā maʻi o ke aʻa a me ke aʻa cranial. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 95.

Waldman SD. Neuralgia Trigeminal. I: Waldman SD, hoʻoponopono. Nā Atlas o nā Syndrome Pain maʻamau. ʻEhā ed. Piladelapia, PA: Elsevier; 2020: chap 10.