Difference between revisions of "2° Clinical case: Pineal Cavernoma"

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As anticipated in the chapter '[[Bruxism - en|Bruxism]]' we will avoid indicating this disorder as an exclusive dental correlate and will seek a broader and essentially more neurophysiological description by making a brief excursus on dystonic phenomena, on 'Orofacial Pain' and only then will we consider the phenomenon 'bruxism' true and own. Subsequently we will move on to the presentation of the clinical case.   

Therefore, the sensitization of the trigeminal nociceptive system and the facilitating effect on mandibular stretch reflexes and CNS hyperexcitability are neurophysiopathogenetic phenomena that can be correlated to pain in the craniofacial region. However, up to now, no correlation has been reported between OP, dysfunction of the mesencephalic nuclei, and facilitation of trigeminal nociception, except for a clinical study on a patient affected by pontine cavernoma, which highlighted a relative facilitation of the trigeminal nociceptive system through the blink reflex.<ref>Katsarava Z, Egelhof T, Kaube H, Diener HC, Limmroth V. Symptomatic migraine and sensitization of trigeminal nociception associated with contralateral pontine cavernoma. Pain. 2003;105(1–2):381–384.[PubMed] [Google Scholar] [Ref list]</ref>

As anticipated we will take up the same diagnostic language presented for the patient Mary Poppins so that it becomes an assimilable and practicable model, and we will try to superimpose it on the present clinical case called 'Bruxer'.<blockquote>The subject was a 32-year-old man suffering from pronounced nocturnal and diurnal bruxism and chronic bilateral OP prevalent in the temporoparietal regions, with greater intensity and frequency on the left side.  The patient came to our observation after being treated for 15 years by dental colleagues with a biteplane. A sort of muscular stiffening of the trunk and legs had recently been added to bruxism and orofacial pain. Come to our observation beyond the clinical signs of bruxism the patient, to neurological examination, showed a contraction of the masseter muscles with pronounced stiffness of the jaw, diplopia and loss of visual acuity in the left eye, left gaze nystagmus with a rotary component, papillae with blurred borders and positive bilateral Babynski’s, and polykinetic tendon reflexes in all four limbs. </blockquote>   

Unlike the patient with 'Hemimasticatory Spasm', the clinical case of our poor 'Bruxer' shows a phenomenon of overlapping of propositions, assertions and logical sentences in the dental and neurological context and apparently neither of the two obtains an absolute and clear compatibility and coherence. This has repercussions in the clinic in which all the actors involved (medical examiners) are right and contextually wrong, making the diagnostic conclusion inadequate and dangerous, but let's see the process as a whole step by step.   

    

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As we described in the chapter '1st Clinical case: Hemimasticatory spasm' the <math>\tau</math> is a representative clinical specific weight, complex to research and develop because it varies from discipline to discipline and for pathologies, essential in order not to collide the logical assertions <math>\Im_o</math> and <math>\Im_n</math> in diagnostic procedures and fundamental to initialize the decryption of the machine language code. Basically it allows you to confirm the coherence of a union <math>\Im\cup\{\delta_1,\delta_2.....\delta_n\}</math> versus another <math>\Im\cup\{\gamma_1,\gamma_2.....\gamma_n\}</math>and vice versa, giving greater weight to the seriousness of the allegations and the report in the appropriate context.