Difference between revisions of "Encrypted code: Bilateral Motor Evoked Potentials of trigeminal root"

This detailed summary examines the complex interrelationships between dental malocclusion, postural disorders, and trigeminal neurophysiopathology through the clinical case of a patient known as 'Balancer.' The patient's decade-long suffering from a meningioma at the base of the skull illustrates the challenges and potential misdiagnoses that can occur when traditional dental perspectives are applied without considering deeper neurophysiological issues. The text integrates a broad range of medical insights to argue for a more nuanced approach to diagnosing and treating conditions that straddle neurology and dentistry.

The chapter opens by highlighting the limitations of axiomatic assumptions in medical diagnoses, particularly in the complex interplay between dental health and neurological conditions. It introduces the case of 'Balancer,' whose symptoms were initially interpreted within a dental framework but later understood to be indicative of significant neurological pathology.

The narrative delves into the specifics of trigeminal neurophysiopathology, explaining how the patient's meningioma exerted physical effects on both sensory and motor fibers of the trigeminal nerve system, leading to severe symptoms that were initially misinterpreted as dental issues. The discussion underscores the importance of considering neurophysiological data in dental diagnoses, particularly when patients present with atypical or severe symptoms that do not align with common dental disorders.

The summary critically evaluates the diagnostic process, emphasizing the role of electrophysiological tests such as the _bRoot-MEPs and assessments of the jaw jerk reflex. These tests revealed the extent of the damage more accurately than dental evaluations and highlighted the need for medical imaging to confirm the presence and impact of the meningioma.

MRI results confirmed the severe implications of the meningioma, showing brainstem displacement and raising urgent questions about the initial stages of the tumor's development. This section reflects on whether earlier detection of the tumor through targeted electrophysiological testing could have altered the patient's treatment trajectory.

Misleading Symptoms and the Importance of Accurate Diagnosis

The patient's case is used to illustrate how symptoms like 'chewing difficulty' can be misleading. The narrative argues for a more integrated diagnostic approach that combines dental and neurological expertise to avoid oversimplified conclusions that may lead to inadequate treatments.

The use of a Cognitive Neural Network (CNN) in diagnosing 'Balancer's' condition is discussed, showcasing how advanced data analysis techniques can aid in distinguishing between symptoms related to dental malocclusions and those stemming from serious neurological conditions. This section details the sequential steps taken through the CNN to refine the diagnosis and better understand the underlying causes of the patient's symptoms.

 

 

 

 

 

 

 

 

 

 

'''Neurological and Dental Integration''' - Focuses on the interdisciplinary approach between neurology and dentistry to tackle complex cases that exhibit symptoms affecting both the neurological and dental systems, crucial for content on comprehensive patient care and diagnostic strategies.</blockquote>{{ArtBy|

</ref> In particular, somatosensory evoked potentials were absent or severely attenuated. Biceps and hamstring T-reflex recordings were normal, while the masseter reflex was absent or attenuated.<blockquote>[[File:Meningioma 2 by Gianni Frisardi.jpeg|link=link=Special:FilePath/Meningioma_2_by_Gianni_Frisardi.jpg|alt=|thumb|'''Figure 1:''' Neurological statement highlighting a severe right jaw jerk latency and amplitude abnormality]]The first observation to be made is that the patients were suffering from chronic spasmodic cough and the second observation was the preservation of the tendon reflexes of the lower limbs. In our patient 'Balancer', on the other hand, there was a total absence of the mandibular tendon reflex<ref>The history of examination of reflexes. Boes CJ.J Neurol. 2014 Dec;261(12):2264-74. doi: 10.1007/s00415-014-7326-7. Epub 2014 Apr 3.PMID: 24695995 </ref> (<math>\gamma_1</math>) so that the neurological damage was very evident at the trigeminal midbrain level. (Figure 1) The multifunctional contribution of the midbrain synaptic circuitry by the proprioceptive nerve endings ( <math>1a</math> e <math>\gamma</math>) are of primary importance both for posture and for cervico-oculomotor reflexes. A very interesting article by Yongmei Chen et al.<ref>Chen Y, Gong X, Ibrahim SIA, Liang H, Zhang J.. Convergent innervations of mesencephalic trigeminal and vestibular nuclei neurons onto oculomotor and pre-oculomotor neurons-Tract tracing and triple labeling in rats. PLoS One. 2022 Nov 28;17(11):e0278205. doi: 10.1371/journal.pone.0278205. eCollection 2022.PMID: 36441755 </ref> showed, through markers, how neurons afferent to the trigeminal mesencephalic nucleus (Vme) from the jaw muscles project to the oculomotor nuclei (III/IV) and their premotor neurons in the interstitial nucleus of Cajal (INC), a well-known pre-oculomotor center that vertically manipulates torsional eye movements.