The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
The pain is more or less continuous, often associated with
exacerbations, but seldom paroxysmal. The patient frequently complains
of heat and tenderness over the areas supplied by the nerve in question
and, in almost every instance, there are points of special tenderness
corresponding as a rule to the emergence of the nerve-trunk through some
osseous foramen. Again, some relief may be obtained by the application
of pressure over the site of that foramen. For example, neuralgia
dependent on antral empyema is most acute in the region of the
infra-orbital foramen, and relief may be experienced by pressure applied
over that foramen.
In the event of failure to discover an exciting cause, some difficulty
may be experienced in coming to a correct conclusion as to whether the
case belongs to the minor types of neuralgia, or should be relegated to
the more serious group of neuralgia major (tic doloreux). In general,
however, the neuralgias minor may be distinguished from the major
variety by the following features:--
(1) The presence of some detectable forms of nerve-irritation. In the
neuralgias major there may be no such cause.
(2) The relief of symptoms on the successful treatment of the cause.
(3) The relative absence of those paroxysmal attacks which are so
typical of neuralgia major.
(4) The infrequence of severe vaso-motor, trophic, and sensory changes
in the regions supplied by the nerve affected. Such changes are more or
less constant in neuralgia major.
(5) The wide distribution of the pain and its reference to other nerves,
with no clear line of demarcation from neighbouring areas supplied by
totally different nerves. In neuralgia major the pain, though often
involving both second and third divisions of the fifth nerve, is
referred to the areas supplied by those nerves only, with a clear line
of demarcation from neighbouring regions.
In cases of neuralgia of doubtful origin one can only observe the effect
of treatment and be guided by the results obtained.
=Treatment.= The source of the neuralgia requires primary consideration.
When this has been rectified the patient should be treated after general
medical principles. In the event of failure at relief, we have two other
strings to our bow--alcohol injections, and neurectomy of the nerve
involved. Alcohol injections are dealt with later. Neurectomy--after
Thiersch’s method of avulsion--is greatly preferable to all the older
methods of neurotomy, nerve-stretching, and nerve-division. These older
methods brought about in their train but transitory alleviation of pain.
Public-domain text, read in full here on John Shaqi.
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