Mixed: somatosensory fibers, somatic motor fibers, visceral sensory fibers, visceral motor fibers

Each spinal nerve trunk is divided into anterior branch, posterior branch, meningeal branch and communicating branch immediately after exiting the intervertebral foramen.

Segmental distribution of skin: T2 → sternal angle; T4 → nipple level; T6 → xiphoid process level; T8 → lower edge of costal arch; T10 → umbilical level; T12 → groin level; in the distribution of nerves in the limbs, the upper and lower ones It is distributed in the proximal part near the trunk, and the middle nerve is distributed in the distal part of the limbs.

Movement disorders: Anterior root injury alone causes movement disorders, while nerve plexus/nerve trunk injuries can also involve sensory and autonomic nerves.

Sensory impairment: Posterior root damage is segmentally distributed sensory impairment accompanied by severe radicular pain; nerve plexus and nerve trunk damage is distribution area sensory impairment accompanied by pain and motor/autonomous nerve dysfunction; nerve ending damage is symmetrical at the distal end of the limb Sexually distributed glove-sock-like sensory impairment with motor and autonomic dysfunction

Reflection changes: shallow reflection and deep reflection weaken/disappear

Autonomic nervous system dysfunction: hyperhidrosis/anhidrosis, pale mucous membranes/cyanosis, decreased skin temperature, skin edema, subcutaneous tissue atrophy, hyperkeratosis, pigmentation, skin ulcers, hair loss, nail gloss loss, nail brittleness, sexual functional impairment, vesicorectal dysfunction, orthostatic hypotension, decreased lacrimal gland secretion

Others: action tremor, peripheral nerve enlargement, deformity, nutritional disorders

Central autonomic nervous system: Parasympathetic nuclei of the cerebral cortex/hypothalamus/brainstem, lateral horn areas of each spinal cord segment

Sympathetic nervous system: C8~L2 spinal cord lateral horn neurons → sympathetic trunk paravertebral ganglia, celiac ganglia → postganglionic fibers distribute along with spinal nerves to sweat glands, blood vessels, smooth muscles, and internal organs

Parasympathetic nervous system: brainstem S2~S4 spinal cord lateral horn neurons → ganglia near organs/intra-organs → postganglionic fibers innervate pupillary sphincter, ciliary muscle, submandibular gland, sublingual gland, lacrimal gland, parotid gland, tracheobronchi, viscera

Sympathetic nerve damage-parasympathetic nerve hyperfunction: miosis, increased salivation, slowed heart rate, dilated blood vessels, decreased blood pressure, increased gastrointestinal motility and digestive gland secretion

Parasympathetic nerve damage - Sympathetic nerve hyperfunction: miosis, exophthalmos, accelerated heart rate, vasoconstriction

contraction, increased blood pressure, accelerated respiration, bronchiectasis, gastrointestinal motility and inhibition of digestive gland secretion

Basic performance

Classification

It is more common in middle-aged and elderly women over 40 years old; often limited to 1/2 branches of the unilateral trigeminal nerve (especially the maxillary nerve and mandibular nerve); as the disease progresses, the number of attacks gradually increases, the attack time gradually extends, the intermittent period shortens, and even It is a persistent attack that rarely heals on its own.

Pain: During the attack, it manifests as severe electric shock-like, acupuncture-like, knife-like, tearing, and burning pain in the upper, lower jaw, and tongue areas of the cheeks, mostly unilateral, lasting 1 to 2 seconds, sudden and intermittent. The symptoms are completely normal; the number of attacks is less at the beginning, and then increases and the pain becomes stronger.

Trigger points/trigger points: The corners of the patient's mouth, nose, cheeks, and tongue are sensitive areas that can induce pain with a light touch.

Painful convulsions (tic douloureux): In severe cases, facial muscle reflex twitching may occur due to pain, and the corners of the mouth may be pulled to the affected side; accompanied by facial skin redness, tears, and salivation.

Nervous system examination: generally no positive signs (this is an important feature of primary trigeminal neuralgia)

Carbamazepine: drug of choice; contraindicated in pregnant women

Others: Phenytoin, Clonazepam, Amitriptyline, Baclofen

Percutaneous semilunar ganglion radiofrequency thermocoagulation therapy: suitable for long-term and medical treatment ineffective/intolerable, elderly and frail patients with systemic diseases who cannot tolerate surgery

Surgical treatment: microvascular decompression, partial sensory rhizotomy of trigeminal nerve, gamma knife treatment

Multiple acute/subacute onset, initially lower back pain/waist stiffness and discomfort

Pain: Typical manifestations are burning/knife-like pain that radiates from the waist to one hip, back of the thigh, popliteal fossa, outside of the calf, and instep. On top of the persistent pain, there are episodic intensifications, especially at night. , aggravated by coughing, sneezing, or straining to defecate; there is often tenderness (but not obvious) in the lumbar spinous process/transverse process at the level of the lesion; special pain relief postures may be used

You may feel pins and needles and numbness on the outer side of the calf and dorsum of the foot on the affected side; the muscle strength of the toe extension/flexion function is weakened, and the ankle reflex is weakened/disappeared

Diagnostic tests: Laségue sign, positive geniothoracic test

Multiple subacute/chronic onset

Pain: Mainly distributed in the sciatic nerve pathway, the waist discomfort is not obvious, but there are tender points (paralumbar points, hip points, popliteal points, gastrocnemius points, ankle points); special pain relief postures may be used

The sensory impairment on the lateral side of the calf and the dorsum of the foot on the affected side is more obvious; the muscles in the area controlled by the sciatic nerve are relaxed with mild muscle atrophy, and the ankle reflex is weakened/disappeared

Diagnostic test: Laségue syndrome is often positive

More common in 20 to 40 years old, more common in men; onset is acute, and facial nerve paralysis reaches its peak within hours to days

Peripheral facial paralysis on the affected side: disappearance of forehead lines, inability to frown, inability to close eye fissures, positive Bell sign/Bell phenomenon (weakness in closing eyes on the affected side → the eyeball moves upward and outward when closing the eyes forcefully to expose the white sclera under the cornea), nose Lip grooves become shallower, mouth corners droop/deviate to the opposite side, air leakage when blowing/whistling

Localization manifestations: Lesions above the chorda tympani may cause loss of taste in the front 2/3 of the ipsilateral tongue; lesions above the stapedius nerve may cause loss of taste in the front 2/3 of the ipsilateral tongue and hyperacusis.

Some people may have persistent pain behind the ear and mastoid tenderness on the affected side 1 to 2 days before the onset of illness.

Hunt syndrome: When the geniculate ganglion is involved, in addition to peripheral facial paralysis on the affected side, loss of taste in the front 2/3 of the tongue, and hyperacusis, there may also be mastoid pain, auricle/external auditory canal sensory disturbance, and external auditory canal/tympanic membrane herpes.

Sequelae: Mainly caused by regenerated nerve fibers growing into adjacent nerve sheath cell pathways

Generally normal; anti-ganglioside antibodies ( ), CJ antibodies ( ) may be present

The number of white blood cells is normal; there is protein-cell separation phenomenon (protein ↑ but <1.0g/L, cells are normal; most obvious in the 3rd to 6th week after onset); the IgG index is elevated, but there are oligoclonal IgG bands in both serum and cerebrospinal fluid; Some may have anti-ganglioside antibodies ( )

Suggests demyelinating disease of peripheral nerves

Auxiliary diagnostic method, but not required examination