Diğer Kranyal Nevraljiler ve Yüz Ağrısının Santral Nedenleri
Özet
Trigeminal nevraljiye kıyasla daha nadir görülen kranyal nevraljiler ve yüz ağrısının santral nedenleri klinik özellikleri, tanı kriterleri, ayırıcı tanıları ve tedavi yöntemleriyle ele alınmaktadır. İncelenen patolojiler arasında glossofaringeal nevralji, nervus intermedius nevraljisi, oksipital nevralji, boyun-dil sendromu, ağrılı optik nörit, iskemik oküler motor sinir paralizisine bağlı baş ağrısı, Tolosa-Hunt sendromu, paratrigeminal okülosempatik sendrom, tekrarlayan ağrılı oftalmoplejik nöropati, yanan ağız sendromu, kalıcı idyopatik yüz ağrısı ile multipl skleroz ve inme sonrası gelişen merkezi nöropatik ağrılar yer almaktadır. Her bir hastalık için ağrının karakteri, tetikleyici faktörleri ve yayılım alanları detaylandırılmıştır. Tanı süreçlerinde klinik muayenenin yanı sıra laboratuvar testleri, bilgisayarlı tomografi ve özellikle nörovasküler basıları ya da demiyelinizan lezyonları saptamak amacıyla manyetik rezonans görüntüleme (MRG) yöntemlerinden yararlanıldığı belirtilmektedir. Tedavi yaklaşımlarında ise birinci basamak olarak karbamazepin, gabapentin ve pregabalin gibi antikonvülsan veya antidepresan ilaçları içeren farmakoterapi tercih edilmektedir. Medikal tedaviye dirençli vakalarda sinir blokajları, puls radyofrekans, perkütan kriyoblasyon ve mikrovasküler dekompresyon (MVD) gibi cerrahi veya invaziv müdahalelerin uygulandığı aktarılmaktadır. Son bölümde ise Uluslararası Başağrısı Derneği (IHS) tarafından yayınlanan ICHD-3 tanı kriterleri sunulmuştur.
Cranial neuralgias, which are rarer compared to trigeminal neuralgia, and central causes of facial pain are discussed with their clinical features, diagnostic criteria, differential diagnoses, and treatment methods. The pathologies examined include glossopharyngeal neuralgia, nervus intermedius neuralgia, occipital neuralgia, neck-tongue syndrome, painful optic neuritis, headache attributed to ischemic ocular motor nerve palsy, Tolosa-Hunt syndrome, paratrigeminal oculosympathetic syndrome, recurrent painful ophthalmoplegic neuropathy, burning mouth syndrome, persistent idiopathic facial pain, and central neuropathic pain developing after multiple sclerosis and stroke. For each disease, the character of the pain, triggering factors, and distribution areas are detailed. It is stated that in diagnostic processes, in addition to clinical examination, laboratory tests, computed tomography, and especially magnetic resonance imaging (MRI) methods are utilized to detect neurovascular compressions or demyelinating lesions. In treatment approaches, pharmacotherapy including anticonvulsant or antidepressant drugs such as carbamazepine, gabapentin, and pregabalin is preferred as the first line. It is reported that in cases resistant to medical treatment, surgical or invasive interventions such as nerve blocks, pulsed radiofrequency, percutaneous cryoablation, and microvascular decompression (MVD) are applied. In the final section, the ICHD-3 diagnostic criteria published by the International Headache Society (IHS) are presented.
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