Results 1 to 1 of 1

Thread: Inflammation of trigeminal nerve in patient with Sjogren's case pictures - NEURORADIOLOGY ATLAS

  1. #1

    Default Inflammation of trigeminal nerve in patient with Sjogren's case pictures - NEURORADIOLOGY ATLAS

    What is neuropathy?
    Neuropathy, which means inflammation and/or damage to the peripheral nerves, can be affect patients with Sjögren’s. Neuropathy can cause various symptoms, from “numbness,” to “coldness;” in its most severe, neuropathy has been described as “burning,” “lancinating” or “feeling like my skin is on fire”. Neuropathy can also cause weakness and clumsiness.

    How does my doctor diagnose neuropathy?
    The first step is to take a careful history and do a physical examination. The pattern and description of symptoms, which may include pain and weakness, may suggest damage to the peripheral nerves. A neurological examination is crucial in providing objective evidence of peripheral neuropathy. Weakness may be present, which is typically greater in the toes and fingers, than in the larger muscle groups of the arms and legs. Your physician may test your reflexes. Whereas a reflex hammer should elicit emphatic lurches of arms and legs, patients with neuropathy may not have any reflexes. Lastly, your physician may test your ability to appreciate temperature, a sharp pin, and vibration. If the neurological examination confirms a peripheral neuropathy, then you may have a nerve-conduction test, looking at the integrity of nerves and muscles.

    Why is neuropathy under-diagnosed or under-treated in Sjögren’s syndrome?
    1. Sjögren’s may uniquely target nerves which are not tested on normal nerve-conduction tests.

    Neuropathy can target nerves either of larger or smaller caliber, respectively referred to as a “large-fiber” neuropathy anda “small-fiber” neuropathy. Symptoms of large-fiber neuropathy include weakness and poorly localizable numbness and are associated with abnormalities on nerve-conduction tests. In contrast, patients with small-fiber neuropathy may have symptoms of pain, burning, and prickling, even without weakness. The nerve-conduction test is only sensitive to damage in the large-fiber nerves. and does not detect abnormalities in the smallest-caliber nerves.

    At Johns Hopkins we obtain skin biopsies when patients with symptoms of small-fiber neuropathy have normal nerve-conduction tests. The skin biopsy allows the clinician to assess damage to the small sensory nerve fibers that innervate the skin, an excellent marker of a small sensory fiber neuropathy, common in Sjogren’s patients.

    2. The lack of any definitive blood tests
    Sjögren’s syndrome is an example of an autoimmune syndrome. In autoimmune disorders, the immune system, which normally protects the body from infection and cancers, may cause injury to the body’s own tissues. In addition to the nervous system, organs which may be targeted in Sjögren’s syndrome include the eye, the lung, the heart, the kidney, and the joints. Many patients with Sjögren’s syndrome have autoantibodies, which bind to the body’s organ tissue and cells. Some examples of autoantibodies in Sjögren’s syndrome include anti-Ro (or SS-A antibodies) and anti-La (or SS-B antibodies).

    However, more than 50% of patients with neurological manifestations of Sjögren’s may not have autoantibodies. In patients who have neuropathy and compelling glandular symptoms of dry eyes and dry mouth, negative blood tests for SS-A and SS-B antibodies do not exclude the diagnosis of Sjögren’s syndrome. In the context of sicca symptoms, further diagnostic studies are warranted, including a Schirmer’s test, and a minor salivary gland biopsy.

    What are other types of neuropathy which can occur in Sjgoren’s syndrome?
    1. Autonomic neuropathy
    Sjögren’s syndrome can cause nerve damage which regulates the coordination of heartbeat, respiration, and gastric motility. This is called an “autonomic neuropathy. Examples of symptoms include lightheadedness when standing, decreased or increased sweating, and feeling full despite eating small meals. The diagnosis of autonomic neuropathy should be made by a neuromuscular specialist.
    Inflammation trigeminal nerve patient with attachment.php?s=4b2fca54000f6591533ed3e7387dfde3&attachmentid=1534&d=1440443579

    2. Trigeminal neuralgia and glossopharyngeal neuralgia
    Sjögren’s syndrome can cause numbness or burning of the face, called “trigeminal neuralgia.” Pain in the back of the throat, which may worsen while swallowing, is called “glossopharyngeal neuralgia.” Patients with trigeminal or glossopharyngeal neuralgia can have agonizing mouth and facial pain. These neuropathies may co-exist with other neuropathies in different parts of the body. For example, up to 20% of patients with a “small-fiber” neuropathy may also have trigeminal neuropathy.

    Medicines which may help alleviate symptoms in small-fiber neuropathy may also have efficacy in trigeminal neuralgia. Such medications may include a class of agents which are typically used to treat seizures, and include gabapentin, topiramate, andpregabalin. In seizure disorders, paroxysmal and irregular bursts of electrical activity in brain nerves may lead to propagation of seizures. Similarly, in Sjögren’s neuropathy, irritative electrical signals produced by nerves in the skin instead of the brain, may similarly contribute to pain. Just as anti-seizure medicines can dampen electrical activity of brain cells, the dampening of electrical activity produced by pain-fibers may ameliorate burning pain. It is important to note that use of these symptomatic medications does not target the neuron-inflammation which may be contributing to neuropathy. In such cases, judicious use of immunosuppressant medications should be considered.

    3. Mononeuritis multiplex
    More severe patterns of weakness or clumsiness may cause weakness or paralysis of different muscles, and is called “mononeuritis multiplex”. These more cataclysmic episodes of numbness or weakness necessitate a thorough diagnostic evaluation, both by nerve-conduction tests, and often by biopsy of nerve and/or muscles. Mononeuritis multiplex occurs when there is inflammation of small blood-vessels. The muscles and nerves nourished by such blood vessels may be deprived of oxygen and nutrients, and is similar to a “stroke of the nervous system.” In such cases, ameliorating symptoms of pain is not sufficient – immunosuppressant therapy is always warranted in cases of mononeuritis multiplex.

    The pace of recovery from mononeuritis multiplex can be frustratingly slow. In some cases, it may be difficult to determine, whether a slow pace of recovery is due to ongoing and ineffectively treated inflammation, or is just a manifestation of the slow process of healing and “rewiring.” In such cases, repeat nerve-conduction tests may be important. Immunosuppresant medications which may be used in the pattern of mononeuritis multiplex includes cyclophosphamide, azathioprine, as well as prednisone.

    How is the neuropathy of Sjögren’s treated?
    In general, a neurologist and/or rheumatologist must determine the “pattern” of neuropathy (i.e. mononeuritis multiplex versus “small-fiber neuropathy). Distinguishing between these patterns is of paramount importance, because of distinguishing mechanisms which may necessitate different therapeutic strategies. The pain of neuropathy can be especially severe and may require different analgesics and anti-seizure medications. However, symptomatic treatment of pain should not preclude the institution of medications to dampen the immune-system, when there is evidence of ongoing neuroinflammation.

    Neurologic complications

    Last edited by Medical Photos; 08-24-2015 at 07:13 PM.

  2. Similar Threads

    1. Myasthenia Gravis case pictures - NEURORADIOLOGY ATLAS
      By Medical Videos in forum Neurology Atlas(Photos of cases)
      Replies: 0
      Last Post: 02-15-2009, 10:13 AM
    2. Pituitary Mass case pictures - NEURORADIOLOGY ATLAS
      By Medical Videos in forum Neurology Atlas(Photos of cases)
      Replies: 0
      Last Post: 02-15-2009, 09:59 AM
    3. Epidural fluid collection case pictures - NEURORADIOLOGY ATLAS
      By Medical Videos in forum Neurology Atlas(Photos of cases)
      Replies: 0
      Last Post: 02-15-2009, 09:52 AM
    4. Calcification of basal ganglia case pictures - NEURORADIOLOGY ATLAS
      By Medical Videos in forum Neurology Atlas(Photos of cases)
      Replies: 0
      Last Post: 02-14-2009, 11:15 AM
    5. SLE, stroke case pictures - NEURORADIOLOGY ATLAS
      By Medical Videos in forum Neurology Atlas(Photos of cases)
      Replies: 0
      Last Post: 02-14-2009, 10:42 AM

Tags for this Thread



Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
About us
Medical Educational Site for Medical Students and Doctors Contains Free Medical Videos ,Atlases,Books,Drug Index ,Researches ,Health and Medical Technology news.
  • Privacy Policy
  • Join us
    Powered by vBulletin® Version 4.2.0 Copyright © 2015
  • vBulletin®
  • Solutions, Inc. All rights reserved. vBulletin Metro Theme by
  • PixelGoose Studio