Neuralgia

Introduction

Introduction

Pain is one of the common symptoms of neurology. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, and the lesions can be divided into peripheral neuropathic pain and central nervous pain.

Pathogen

Cause

Pain is one of the common symptoms of neurology. This kind of pain refers to the pain that is felt without external stimuli, also known as spontaneous pain. There are many types of spontaneous pain, which can be divided into:

First, peripheral neuropathic pain

1, trigeminal neuralgia: common in inflammatory infiltration, atherosclerotic compression and cerebellopontine angle tumor, nasopharyngeal carcinoma, trigeminal ganglion tumor, chordoma, multiple sclerosis.

2, sphenopalatine ganglion pain, pterygopalatine pain, genic ganglion pain: seen in sinusitis, sphenoid sinusitis, ethmoid sinusitis, nasal structural deformation, nasal septum bending due to mechanical compression of the middle turbinate, skull base fracture, metastasis Cancer, banding diagnosis of viral infections, etc.

3, occipital neuralgia: common in neuritis, upper respiratory tract infection, influenza, malaria, rheumatism, diabetes, thyroid disease, alcohol, lead poisoning, occipital, neck trauma, cervical spondylosis, rheumatoid spondylitis Or metastatic cancer, skull base recession, occipital foramen stenosis, sacral occipital fusion, atlantoaxial dislocation, upper cervical vertebral insufficiency, cerebellar tonsil sacral, intraspinal tumor, occipital macropore area tumor, adhesive spinal spider web Membrane inflammation, syringomyelia, ligament injury of the suboccipital joint, anterior and posterior arch fracture of the atlas, atlantoaxial subluxation, and cervical muscle injury.

4, intercostal neuralgia: common in infectious and toxic radiculitis, pleurisy, chronic pneumonia, aortic aneurysm, mitral stenosis, thoracic organ disease, thoracic tuberculosis, tumor, ankylosing spondylitis, myeloma, spinal cord Spinal lesions such as inflammation, rib tumors, rib fractures, osteophytes, and herpes zoster.

5, neck and shoulder arm neuralgia, brachial plexus neuritis: common in cervical osteoarthrosis, neck mass, tumor, herpes zoster, influenza, plaque diagnosis of cold and malaria infection, cold, inoculation of xenogeneic serum vaccine.

6, ulnar nerve pain, median nerve pain and lateral femoral neuralgia seen in neuritis, trauma, local inflammation and oppressive lesions.

7, femoral neuralgia and sciatica: seen in nerve root lesions such as tumor compression, lumbar disc herniation, tumor, inflammation and other diseases.

8, tail bone pain: seen in trauma, fractures and so on.

9, burning neuralgia: seen in trauma such as knife cuts, crush injuries, heavy injuries, especially firearm injuries, chemical damage, infection and so on.

10, herpes zoster: the cause is caused by varicella-zoster virus.

Second, central pain

1, spinal pain

(1) Posterior horn pain is more common in trauma, tumor, syringomyelia and so on.

(2) Post-spinal pain is seen in multiple sclerosis and spinal cord spasm.

(3) Spinal thalamus pain is more common in syringomyelia.

2, thalamic pain, thalamic pain, cerebrovascular disease, tumors are more common.

3, pons, medullary pain seen in cerebrovascular disease, tumors, multiple sclerosis.

4, cerebral cortical pain cerebral cortex pain is rare, generally for tumors, vascular diseases and so on. Peripheral pain and central nervous pain.

Examine

an examination

Related inspection

Tube agglutination test Herpes simplex virus (HSV) Schistosoma japonicum egg precipitation test Schistosoma antibody prolactin (PRL)

Physical examination

Neuralgia is a common disease in neurology. It is a subjective narrative. Detailed physical examination should be performed according to the patient's prompts. It is possible to confirm the diagnosis and differential diagnosis from physical examination. Reasonable examination should be carried out according to the medical history. For example, peripheral nerve pain and head pain should be paid attention to such as fundus examination, head and ear, sinus, oral examination and presence or absence of signs of nervous system positioning. The pain of the spinal nerve should pay attention to whether the local muscle has atrophy, weakness, muscle tension, involuntary movement and mutual aid exercise, gait, deep and shallow feeling and compound feeling and local presence or absence of sensory disturbance. Various reflections such as deep and shallow reflections, pathological reflexes, meningeal irritation signs, and special pain relief postures in pain areas. For central pain, attention should be paid to examinations such as fundus examination, head examination and signs of nervous system localization.

Auxiliary inspection

1, peripheral nerve pain

(1) Head and face nerve pain: paranasal sinus plain film, brain CT or MRI, lumbar puncture examination.

(2) spinal nerve pain: flat radiograph, spinal CT or MRI, lumbar puncture examination, myelography, electromyography, etc.

2, central pain is generally selected by brain CT or MRI, EEG and other examinations.

Diagnosis

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Occipital neuralgia: refers to paroxysmal or persistent pain in the distribution of the occipital nerve (posterior occipital), and may also be paroxysmal on the basis of persistent pain. The clinical manifestations are acupuncture, knife cutting or burning pain on one or both sides of the posterior occiput or both. The patient does not dare to turn his head when the pain occurs, and the head and neck are sometimes in a straight state. Physical examination showed that there was tenderness at the exit of the large nerve, and the area of the occipital nerve (C2-3) was hyperalgesia or decreased from below the ear line to the hairline.

2. Post-herpetic neuralgia: a neuropathic pain syndrome that occurs after infection with acute herpes zoster. Most patients with herpes zoster can be recovered after treatment, but some patients have pain in the damaged skin area after herpes has healed for more than 3 months, called post-herpetic neuralgia.

3. Sciatica: refers to sciatic neuropathy, a group of painful symptoms along the sciatic nerve pathway, ie, the waist, hips, back of the thigh, posterior aspect of the lower leg, and lateral aspect of the foot. The sciatic nerve is the main nerve trunk that governs the lower extremities. Sciatica refers to pain in the sciatic nerve pathway and its distribution (hip, back of the thigh, posterior aspect of the calf, and lateral aspect of the foot).

4. Intercostal neuralgia: refers to the frequent pain that occurs in one or several intercostal areas, and has a paroxysmal increase. Primary intercostal neuralgia is rare, and secondary infections are associated with viral infections, toxin stimulation, mechanical damage, and foreign body oppression. The pain is mostly stinging or burning and is distributed along the intercostal nerves. In the onset of intercostal neuralgia, it can be seen that the pain is delayed from the posterior to the posterior, along the corresponding intercostal space; the pain is stinging or burning pain. Pain worsens when coughing, taking a deep breath, or sneezing. The pain is more common in one nerve on one side.

5. Syncope caused by glossopharyngeal neuralgia or other visceral diseases: this type of syncope is rare. Transient syncope occurs in glossopharyngeal neuralgia, biliary colic, renal stenosis, bronchial or digestive tract endoscopy. Associated with severe pain and hyperreflexive responses to visceral receptors.