Browse > Article

The Dizziness Caused by a Vestibular Schwannoma was Misinterpreted as a Side Effect of an Anticonvulsants Drug -A case report-  

Kim, Dong Hee (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University)
Hwang, Dong Sup (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University)
Park, Sang Wook (Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University)
Publication Information
The Korean Journal of Pain / v.18, no.2, 2005 , pp. 218-221 More about this Journal
Abstract
This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.
Keywords
anticonvulsant; dizziness; trigeminal neuralgia; vestibular schwannoma;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Loeser JD: Cranial neuralgia. In Bonica's management of pain. 3rd ed. Edired by LoeserJD: Philadelphia, Lippincorr Williams & Wilkins. 2001, pp 855-6l.
2 Barker FG 2nd, Jannerra PJ, Babu RP, Pomonis S, Bissonerre DJ, Jho HD: Long-rerm ourcome afrer operarion for rrigeminal neuralgia in patients wirh posterior fossa tumors. J Neurosurg 1996; 84: 818-25.
3 Lin D, Hegarty JL, Fischbein NJ, Jackler RK: The prevalence of "incidental" acoustic neuroma. Arch Orolaryngol Head Neck Surg 2005; 131: 241-4.
4 Hanabusa K, Morikawa A, Murara T, Taki W: Acoustic neuroma with malignant transformarion: case report. J Neurosurg 2001; 95: 518-2l.
5 Sweet WH, Wepsic JG: Controlled thermoregulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: 1. Trigeminal neuralgia. J Neurosurg 1974; 40: 143-56.
6 Deen HG, Ebersold MJ, Harner SG, Bearry CW, Marison MS, Wharen RE, et al: Conservative management of acoustic neuroma: an ourcome study. Neurosurgery 1996; 39: 260-6.
7 Chong MS, Bajwa ZH: Diagnosis and treatment of neuropathic pain. J Pain Symprom Manage 2003; 25(5 Suppl): S4-S1l.
8 Wilkins RH: Tic douloureux. Conrernp Neurosurg 1986; 8: 1-6.
9 Khan OA: Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology 1998; 51: 611-4.
10 Chan Kim, Hyo Keun Lee, Seong Mo Kim: Trigeminal neuralgia which caused by Brain rumor or cerebrovascular disease. Korean J Pain 1996; 9: 395-8.
11 Spina E, Perugi G: Antiepileptic drugs: indications other than epilepsy. Epileptic Disord 2004; 6: 57-75.
12 Cheng TM, Cascino TL, Onofrio BM: Comprehensive srudy of diagnosis and treatment of rrigeminal neuralgia secondary ro rumors. Neurology 1993; 43: 2298-302.
13 Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD: Results of acousric neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 2001; 94: 1-6.
14 Kondziolka D, Lunsford LD, Flickinger J C: Stereoractic radiosurgery for the treatment of rrigeminal neuralgia. Clin J Pain 2002; 18: 42-7.
15 Darlow LA, Brooks ML, Quinn PD: Magnetic resonance imaging in the diagnosis of trigeminal neuralgia. J Oral Maxillofac Surg 1992; 50: 621-6.
16 Mullan S, Lichror T: Percutaneous microcompression of the trigeminal ganglion for rrigeminal neuralgia. J Neurosurg 1983; 59: 1007-12.
17 Bederson JB, Von Ammon K, Wichmann WW, Yasargil MG: Conservative rreatment of patient with acoustic rumors. Neurosurgery 1991; 28: 646-5l.
18 Puca A, Meglio M, Tamburrini G, Vari R: Trigeminal involvement in intracranial rumors: anaromical and clinical observations on 73 patients. Acra Neurochir 1993; 125: 47-5l.
19 Foote RL, Coffey RJ, Swanson JW, Harner SG, Bearry CW, Kline RW, et al: Stereotactic radiosurgery using the gamma knife for acoustic neuromas. lnt J Radiat Oncol Bioi Phys 1995; 32: 1153-60.
20 Bullirr E, Tew JM, Boyd J: Intracranial rumors in patients with facial pain. J Neurosurg 1986; 64: 865-7l.