Abstract：
Trigeminal neuralgia (TN) is a paroxysmal, unilateral, brief, shock-like pain in ≥1 divisions of the trigeminal nerve. It can result from multiple causes; however, TN secondary to stroke is very rare.
We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to 2022.
Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm3. The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events.
Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.
We present the case of TN secondary to pontine infarction treated with incremental doses of neuropathic pain medication for >5 years before conservative management failed. He was then treated with stereotactic radiosurgery (SRS). Additionally, we conducted a systematic review using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all the cases of TN with brainstem stroke from 1976 to 2022.
Our patient was an 82-year-old man. Magnetic resonance imaging demonstrated a pontine lesion consistent with stroke. The Barrow Neurological Institute (BNI) score at presentation was 5. He received a marginal dose of 60 Gy to the 80% isodose line in a single fraction to a volume of 0.05 cm3. The immediate post-treatment BNI score was 0 and remained at 0 for 3 months, when he experienced recurrence. The recurrence was treated with oxcarbazepine. His pain remained well controlled with a lower dose of oxcarbazepine, and he had no adverse effects at 1 year of follow-up with a BNI score of 3. The systemic review identified 21 case reports with a combined cohort of 25 patients with TN secondary to stroke. Only 3 patients were treated with SRS, 2 of whom reported symptom improvement at 6 months and 8 months of follow-up with no adverse events.
Our case and literature review demonstrate durable and effective treatment with SRS, which can be considered a safe and effective treatment option for patients with stroke-associated TN.
摘要：
背景：三叉神经痛（TN）是一种阵发性，单边,brief,三叉神经≥1个分区的休克样疼痛。它可能是由多种原因造成的；然而，继发于中风的TN非常罕见。
方法：我们介绍了在保守治疗失败之前，使用递增剂量的神经性疼痛药物治疗>5年的脑桥梗死继发TN的案例。然后，他接受了立体定向放射外科（SRS）治疗。此外,我们使用标准PRISMA(系统评价和荟萃分析的首选报告项目)指南对1976年至2022年的所有TN伴脑干卒中病例进行了系统评价.
结果：我们的患者是一名82岁的男性。磁共振成像显示脑桥病变与中风一致。巴罗神经研究所（BNI）在演示时得分为5。他接受60Gy的边缘剂量至80％等剂量线，以单个部分的体积为0.05cm3。治疗后即刻BNI评分为0,持续3个月保持在0,当他经历了复发。复发采用奥卡西平治疗。使用较低剂量的奥卡西平，他的疼痛得到了很好的控制，随访1年,BNI评分为3分,无不良反应.该系统评价确定了21例病例报告，其中25例合并脑卒中继发TN患者。只有3名患者接受了SRS治疗，其中2人在随访6个月和8个月时报告症状改善，无不良事件。
结论：我们的病例和文献综述证明了SRS的持久有效治疗，这可以被认为是卒中相关TN患者安全有效的治疗选择。
方法：我们介绍了在保守治疗失败之前，使用递增剂量的神经性疼痛药物治疗>5年的脑桥梗死继发TN的案例。然后，他接受了立体定向放射外科（SRS）治疗。此外,我们使用标准PRISMA(系统评价和荟萃分析的首选报告项目)指南对1976年至2022年的所有TN伴脑干卒中病例进行了系统评价.
结果：我们的患者是一名82岁的男性。磁共振成像显示脑桥病变与中风一致。巴罗神经研究所（BNI）在演示时得分为5。他接受60Gy的边缘剂量至80％等剂量线，以单个部分的体积为0.05cm3。治疗后即刻BNI评分为0,持续3个月保持在0,当他经历了复发。复发采用奥卡西平治疗。使用较低剂量的奥卡西平，他的疼痛得到了很好的控制，随访1年,BNI评分为3分,无不良反应.该系统评价确定了21例病例报告，其中25例合并脑卒中继发TN患者。只有3名患者接受了SRS治疗，其中2人在随访6个月和8个月时报告症状改善，无不良事件。
结论：我们的病例和文献综述证明了SRS的持久有效治疗，这可以被认为是卒中相关TN患者安全有效的治疗选择。
