ROLE AND IMPORTANCE OF CEREBRAL HEMODYNAMICS IN THE COURSE OF TRIGEMINAL NEURALGIA

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 36 ROLE AND IMPORTANCE OF CEREBRAL HEMODYNAMICS IN THE COURSE OF TRIGEMINAL NEURALGIA D.T. Xodjiyeva1, D.N. Juraeva2 Bukhara State Medikal Institute, Jondor regional medical association1,2 https://doi.org/10.5281/zenodo.17394145 Abstract. We conducted research on 67 (31 patients of women (46,3%), 36 patients of men (53,7%)) patients with trigeminal neuralgia who applid in 20 24 in the neurology room of the multi network central polyclinik of Jondor district medical association of Bukhara region. Allpatientis underwent transcranial dopplerography. Keywords: neuralgia of a trigeminal nerve, sense, pain of syndrome. Introduction It has been extensively documented that recent studies have shown that compression of the trigeminal nerve root at the entrance to the pons is most often associated with pathological curvature of the superior cerebellar artery (1,2,3,4,6,7). This is explained by the fact that trigeminal neuralgia occurs in the elderly and senile age and is completely absent in children (7). In recent years, the pathogenesis of certain brain diseases has been studied from the perspective of the body's functional systems. This helps to identify the mechanisms of previous and new pathological phenomena (3,5,7). Despite the fact that the acute phase of trigeminal neuralgia and its etiopathogenesis have now been studied, the lack of comprehensive treatment continues to create problems. This, in turn, requires studying the disease based on modern research. During remission, the phobic syndrome persists; patients, fearing a relapse, constantly chew food on the opposite side and cover their heads even in hot weather. Several decades may pass during the development of pain attacks, with remissions and exacerbations. However, over time, in old age, typical neuralgic attacks develop into neuropathic attacks, characterized by mild pain. The intensity of acute pain diminishes, and constant, mild, atypical facial pain develops (8, 9, 10). Research has consistently demonstrated that pain attacks most often develop in the morning or afternoon, less often in the evening. Pain occurs in the second or third horn, sometimes in both horns. Neuralgia of the first horn is rare and requires careful diagnosis. Similar symptoms are observed with frontal sinusitis, local inflammatory processes, sinus (cavity) thrombosis, etc. However, most often, pain radiates from the second to the first branch of the trigeminal nerve (9, 10, 11). Trigeminal neuralgia manifests in approximately 30–35% of cases with paroxysmal pain, decreased sensitivity, tingling sensations, and a constant dull, aching pain in the teeth and, less commonly, the jaws. Approximately one-third of patients undergo various dental procedures for these complaints, including the extraction of intact (unchanged) teeth (9, 10, 11). Ultrasound examination of the main cerebral arteries has been widely used in clinical practice since the 1980s. Currently, transcranial Doppler sonography is a convenient and versatile method for assessing the functional state of cerebral circulation, due to its high information content, safety, and the ability to be used repeatedly over time. This method allows one to examine the hemodynamic state of the main cerebral arteries, simultaneously determining the maximum (systolic), minimum (diastolic), and average blood flow velocities, as well as the pulsatility index (the ratio of systolic and diastolic blood flow velocities to the average blood flow velocity). SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 37 Gender-specific patterns in the course of trigeminal neuralgia depend not only on gender, etiological factors, and environmental influences, but also on cerebral hemodynamics, as cerebral hemodynamics plays a significant role in the choice of treatment strategy. Changes in cerebral circulation in trigeminal neuralgia are also associated with the degree of vascular stenosis. Transcranial Doppler ultrasonography is a noninvasive and convenient method for determining the condition of intracranial vessels and blood flow velocity. Aim of the checking: To study changes in cerebral hemodynamics in trigeminal neuralgia in individuals of different sexes. Materials and Methods: The state of blood vessels and hemodynamic parameters, and in some cases the causes of the disease, as well as changes in the main cerebral arteries, were studied using transcranial dopplerography with duplex scanning in 67 patients who sought medical attention at the neurology department of the multidisciplinary medical association in the Zhandorsky district of the Bukhara region in 2024. The patients were divided into 2 groups: Group 1 - women - 31 patients (mean age 54 years), Group 2 - men - 36 patients (mean age 52 years). Results and discussion. It is widely acknowledged that to compare changes in cerebral hemodynamics: Doppler ultrasound (USDG) + color duplex scanning: Group 1 - 31 patients, Group 2 - 36 patients; TCDG: 28 patients in Group 1, 32 patients in Group 2. Table 1. Pathological changes in the main vessels of the head and neck. Changes in blood vessels I group II group N % n % S-Simonegry 7 22,5 12 33,3 C-Simonegrys 6 19,3 9 25 The combination of S and Csimonegriism 9 29 12 33,3 Stenosis: - common carotid artery - internal carotid artery - common artery 3 5 4 6,4 16,1 12,9 10 12 9 27,7 33,3 25 Change in the direction of the exit of the vertebral artery 19 61,3 27 75 The results showed that among the pathologies of the main arteries in group 1 patients, the most common was the change in the direction of the vertebral artery, which was detected in 19 (61.3%) patients, which, in our opinion, is associated with osteochondrosis of the cervical spine. The main factor affecting blood circulation in the brain is the S or C-Simon curvature of the internal carotid artery or their combination, which was detected in 22 (56.4%) patients. This change is associated with the development of hypertensive angiopathy, which was observed mainly in patients with long-term hypertension. The presence of these changes, similar to stenosis, creates conditions for impaired cerebral hemodynamics and affects the course of the disease. In group 2 patients, atherosclerotic plaques were detected mainly in the area of the bifurcation of the right common carotid artery, as well as in the proximal parts of the internal carotid artery in 31 (86.1%) patients, and in 11 (30.5%) patients, signs of varying degrees of atherosclerotic process were detected in all main arteries. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 38 It is important to emphasize that using TCDG, systolic, diastolic and mean cerebral blood flow velocity, resistance and systolic-diastolic index were studied in patients. Table 2. Systolic (Vmax, cm/sec) and diastolic blood flow velocity (Vmin, cm/sec) in the main cerebral arteries in trigeminal neuralgia, depending on gender. Arteries Systolic Diastolic 1group 2group 1group 2group dias. sys. dias. sys. dias. sys. dias. sys. UUA M ±m 50,4 2,5 47,7 2,7 51,5 3,9 49,1 3,2 9,2 1,7 7,5 1,7 9,1 1,4 7,7 1,5 IUA M ±m 55,6 2,7 45,3 2,8 49,2 2,6 45,9 2,3 23,1 0,9 19,1 1,5 20,1 1,1 17,9 1,2 TUA M ±m 69,1®® 3,9 71,0 ΔΔΔ 3,5 47,4®® 5,4 46,0 ΔΔΔ 2,0 15,2®® 0,8 14,2 Δ 2,5 9,4®® 1,4 8,2 Δ 0,6 BМУА М ±м 104,7 8,6 113 Δ 8,4 97,8 14,1 87,9 Δ 5,3 20,8®® 1,7 23,7 2,4 10,7®® 3,0 13,2 5,4 BMOA M ±m 60,4 2,8 61,6 3,0 58,5 3,4 53,7 3,6 17,6 0,9 15,1 1,5 19,2 2,1 17,2 1,9 UА М ±м 46,1 2,5 45,4 3,9 38,3 4,07 35,8 3,5 13,0 1,6 12,0 2,1 13,9 1,6 14,9 1,7 ®®-p<0,01 - reliability level between groups I and II in the right hemisphere of the brain Δ-p<0.05; ΔΔΔ-p<0.001 – reliability level between groups I and II in the left hemisphere of the brain As can be seen from the table, no significant gender differences were found in systolic blood flow velocity in the common and internal carotid arteries, posterior cerebral artery, and vertebral artery. In patients of group 2, the significance level for the external carotid artery was r<0.01 in the right cerebral hemispheres compared with patients of group 1, and r<0.001 in the left hemispheres. Systolic blood flow velocity in the middle cerebral artery in the left cerebral hemispheres of patients of group 2 averaged 87.9±5.3 cm/s (r<0.05), while no significant difference was observed in the right hemispheres. From the Table 2, in the right cerebral hemispheres, only changes were observed in the external carotid artery; diastolic blood flow velocity was 15.2±0.8 cm/s in patients of group 1; In patients in Group 2, it was 9.4±1.4 cm/s, with a significance level of p<0.01 in Groups I and II. In the middle cerebral artery, diastolic blood flow velocity also differed in patients in Group 2 (10.7±3.0 cm/s) compared to patients in Group 1 (20.8±1.7 cm/s). In other arteries, namely the SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 39 common carotid artery, posterior cerebral artery, and spinal artery, the significance level was not determined. Table 3. Changes in mean cerebral blood flow velocity (Vavg, cm/s) in the main cerebral arteries in trigeminal neuralgia depending on gender. Arteries 1group 2group dias. sys. dias. sys. UUA M ±m 29,8 1,8 27,6 2,0 30,3 2,6 28,4 2,3 IUA M ±m 39,3® 1,5 32,2 2,0 34,6® 1,8 31,9 1,7 TUA M ±m 42,1®® 2,2 ΔΔΔ 42,6 2,4 27,7®® 3,3 ΔΔΔ 27,1 1,2 BМУА М ±м 62,7 4,7 68,3Δ 5,0 54,3 7,8 50,5Δ 4,9 BMOA M ±m 39,0 1,6 38,3 1,9 38,8 2,7 35,4 2,7 UА М ±м 29,6 2,0 28,7 3,0 26,1 2,8 27,8 5,7 ®-p<0,05; ®®-p<0,01 - reliability level between groups I and II in the right hemisphere of the brain Δ-p<0.05; ΔΔΔ-p<0.001 – reliability level between groups I and II in the left hemisphere of the brain It can be clearly observed that the results of the analysis of the average cerebral blood flow velocity showed that the average cerebral blood flow velocity in the middle cerebral artery in patients of Group 1 differed significantly from that in patients of Group 2 (p<0.05 in Groups I and II). It should be noted that the average cerebral blood flow velocity in the external carotid artery also differed significantly between the groups, particularly in the left hemispheres of the brain: in Group 1 – 42.6±2.4 cm/s; in Group 2 – 27.1±1.2 cm/s. When analyzing the systolic-diastolic index (SDI) (to determine vascular wall elasticity) and the pulsatility index (PI) (to assess the level of peripheral vascular resistance in the cerebral artery), an increase in the average value was noted depending on the patient's gender and age. This indicates an increase in vascular resistance in the cerebral capillary system, which may be associated with the progression of cerebrovascular insufficiency. However, no signs of intracranial hypertension were observed in this group of patients. It is evident from the data that the EEG data in patients with trigeminal neuralgia, dividing them into two groups: women and men, and compared the results. The results showed that the rise time (α time) of the waves was longer in women than in men (0.165 ± 0.007: 0.143 ± 0.0071, p ≤ SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 40 0.05). The opposite pattern was observed in men: the decay time (β time) of the waves was longer than in women. We found that the resistance index (0.164 ± 0.004: 0.157 ± 0.004) was higher in men, while the dicrotic index (78.0 ± 4.39: 66.7 ± 3.4, p ≤ 0.05) was higher in women than in men. This suggests that vascular tone is higher in women during an attack of trigeminal neuralgia. It can be concluded that cerebral blood flow differs from normal in trigeminal neuralgia, which, in turn, indicates increased autonomic activity in women during an attack of neuralgia. The results are presented in Table 5. Table 4 Changes observed in REG during an attack of the disease № Indicators Women n-35 Men n-30 p≤ 1 α 0,165±0,007 0,143±0,0071 0,05 2 β 0,727±0,006 0,743±0,0048 0,05 3 PI 0,157±0,004 0,164±0,004 - 4 DI 78,0±4,39 66,7±3,4 0,05 It should be noted that repeat rheoencephalographic study of patients in remission from trigeminal neuralgia. The results of the repeat study showed that during remission, a decrease in vascular tone is observed, particularly in women. The decrease in wave propagation time was particularly pronounced in women (the α time in women during an attack was 0.165 ± 0.007, and during remission, 0.143 ± 0.006). The findings indicate that during remission, patients of both sexes showed a decrease in the resistance index and dicrotic index. In women, a decrease in vascular tone was observed during remission, which may be associated with the disappearance of pain, a decrease in anxiety, and a decrease in autonomic nervous system activity. The results of the REG study showed that during an exacerbation of idiopathic trigeminal neuralgia, women, compared to men, exhibit increased autonomic nerve function, particularly sympathetic fibers, leading to increased vascular tone (p≤0.05), whereas during remission, a decrease in tone is observed. The results are presented in Table 6. Table 5 Changes observed in the REG study during remission № Indicators Women n-35 Men n-30 p≤ 1 Α 0,143±0,006 0,139±0,0048 - 2 Β 0,719±0,006 0,731±0,0046 - 3 PI 0,145±0,0025 0,155±0,003 0,05 4 DI 74,4±3,39 65,4±2,9 0,05 Conclusion: 1. Based on the above results, it can be concluded that changes in cerebral hemodynamics often depend on the patient's gender. Atherosclerotic lesions of multiple major arteries or widespread atherosclerosis, reduced blood flow in the middle cerebral artery, and blood flow deficits in the main arteries—all these factors collectively influence the course and consequences of the disease, contributing to the specific course of trigeminal neuralgia, which is of great importance for treatment. 2. The study of cerebral vessels using REG revealed that women were significantly more likely (p≤0.05) to experience arterial hypertension during an attack than men, which, in turn, indicates stronger sympathetic activity of the autonomic nervous system in women. Trigeminal SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 10 OCTOBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 41 nerve fibers are known to also contain sympathetic autonomic fibers, and the study results showed that this anatomical condition is more developed in women. REFERENCES 1. Afanasyeva E.V. 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