Paroxysmal Trigeminal Pain with Tumours of the Nervus Acusticus.

Abstract

IN 1910 Weisenburg 1 published a communication Vnder the title ' Cerebellopontine tumour diagnosed for six years as tic douloureux.' This was the first recorded case of a particular type of pain associated with acoustic neurofibroma. The next important phase in the study of this particular tumour was Cushing's 2 book Tumours of the Nervus Acusticus in 1917. In the series Cushing reported including 80 cases of the disease there were only four cases where there was any complaint of pain at all. In none of them was pain conspicuous, persistent, or in any way like that associated with tic douloureux. In 1928 I3 made a study of 53 cases of tumours of the acoustic nerve. Only those cases were taken in which the diagnosis had been established by microscopic study of tumour tissue obtained either at operation or at necropsy. In each case there had been a neurological examination and a careful study to determine the degree of involvement of the fifth nerve. In only four cases in the entire series was there any disturbance of sensation which could be described as pain. In only one of these four was the pain a dominant and persistent symptom and one which played the major part in the patient's complaint of symptoms. In the remaining three pain was only transitory and not conspicuous during the course of illness. In the case of the one patient who had .persistent pain the interesting feature was that the type of pain corresponded exactly to the syndrome known as tic douloureux. The earlier signs of deafness and nystagmus were inconspicuous, and of more interest still was the fact that the pain became relieved by the usual treatment for tic douloureux, namely, injection of the nerve with alcohol. It was only later with the advent of vomiting, ataxia and vertigo, that the true nature of the patient's condition was appreciated. To this experience, two more examples may be added.