JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Evaluation of hematologic inflammation parameters and cranial magnetic resonance imaging findings in patients with trigeminal neuralgia
Abstract
Aims: This study aimed to evaluate the relationship between trigeminal neuralgia (TN) and hematological parameters, including leukocyte-based inflammatory indices, and to explore their association with cranial magnetic resonance imaging (MRI) findings.
Methods: A retrospective analysis was conducted on 114 patients with newly diagnosed TN and 114 healthy control groups with comparable demographic characteristics. Clinical, laboratory, and cranial MRI data were collected from hospital records. White matter abnormalities were identified via cranial MRI, and inflammatory indices were calculated as follows: neutrophil-to-lymphocyte ratio (NLR)=Neutrophil count/lymphocyte count, platelet-to-lymphocyte ratio (PLR)=Platelet count/lymphocyte count, Systemic Immune-Inflammation Index (SII)=Platelet count×neutrophil count/lymphocyte count, and Systemic Inflammatory Response Index (SIRI)=Neutrophil count×monocyte count/lymphocyte count.
Results: TN patients showed significantly higher leukocyte counts (7.4±1.8 vs. 6.0±1.9 ×10³/µl, p<0.001), neutrophil counts (4.2±1.1 vs. 2.8±0.8×10³/µl, p<0.001), CRP levels (median: 2.6 vs. 0.8 mg/dl, p<0.001), and inflammatory indices (NLR, PLR, SII, and SIRI; p<0.001 for all) compared to control group. White matter abnormalities were detected in 16.7% of TN patients, predominantly in the frontal (11.4%) and parieto-occipital (7.0%) regions. Patients with white matter abnormalities exhibited significantly higher inflammatory indices than those without. Compared to other inflammatory parameters, SIRI demonstrated the highest diagnostic performance for TN (threshold: 0.7; sensitivity: 84.2%, specificity: 82.5%) and white matter abnormalities (threshold: 1.3; sensitivity: 78.9%, specificity: 82.1%).
Conclusion: Inflammatory markers, particularly SIRI, are significantly elevated in TN patients and are associated with white matter abnormalities. These markers may serve as useful non-invasive tools for predicting TN and related MRI findings.

Keywords : Trigeminal neuralgia, inflammation markers, white matter lesions, cranial MRI, Inflammation Index

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1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3<sup>rd</sup> edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202
2. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289-299. doi:10.2147/TCRM.S37592
3. Jones MR, Urits I, Ehrhardt KP, et al. A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep. 2019;23(10):74. doi:10. 1007/s11916-019-0810-0
4. Chen Q, Yi DI, Perez JNJ, et al. The molecular basis and pathophysiology of trigeminal neuralgia. Int J Mol Sci. 2022;23(7):3604. doi:10.3390/ijms 23073604
5. Peker S, Kurtkaya O, Uzun I, Pamir MN. Microanatomy of the central myelin-peripheral myelin transition zone of the trigeminal nerve. Neurosurgery. 2006;59(2):354-359. doi:10.1227/01.NEU.0000223501.27220.69
6. Love S, Hilton DA, Coakham HB. Central demyelination of the 5<sup>th</sup> nerve root in trigeminal neuralgia associated with vascular compression. Brain Pathol. 1998;8(1):1-11. doi:10.1111/j.1750-3639.1998.tb00126.x
7. Wang J, Ou SW, Wang YJ. Distribution and function of voltage-gated sodium channels in the nervous system. Channels (Austin). 2017;11(6): 534-554. doi:10.1080/19336950.2017.1380758
8. Laedermann CJ, Abriel H, Decosterd I. Post-translational modifications of voltage-gated sodium channels in chronic pain syndromes. Front Pharmacol. 2015;6:263. doi:10.3389/fphar.2015.00263
9. Levinson SR, Luo S, Henry MA. The role of sodium channels in chronic pain. Muscle Nerve. 2012;46(2):155-165. doi:10.1002/mus.23314
10. Ostertag C, Friedman TN, Keough MB, Kerr BJ, Sankar T. Heightened presence of inflammatory mediators in the cerebrospinal fluid of patients with trigeminal neuralgia. Pain Rep. 2023;8(6):e1117. doi:10.1097/PR9. 0000000000001117
11. Ericson H, Abu Hamdeh S, Freyhult E, et al. Cerebrospinal fluid biomarkers of inflammation in trigeminal neuralgia patients operated with microvascular decompression. Pain. 2019;160(11):2603-2611. doi: 10.1097/j.pain.0000000000001649
12. Wang Y, Cao DY, Remeniuk B, Krimmel S, Seminowicz DA, Zhang M. Altered brain structure and function associated with sensory and affective components of classic trigeminal neuralgia. Pain. 2017;158(8): 1561-1570. doi:10.1097/j.pain.0000000000000951
13. Obermann M, Rodriguez-Raecke R, Naegel S, et al. Gray matter volume reduction reflects chronic pain in trigeminal neuralgia. Neuroimage. 2013;74:352-358. doi:10.1016/j.neuroimage.2013.02.029
14. Yao Y, Chang B, Li S. Relationship of inflammation with trigeminal neuralgia. J Craniofac Surg. 2020;31(2):e110-e113. doi:10.1097/SCS.0000 000000005879
15. Altunisik E, Tak AZA. Comparison of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients diagnosed with trigeminal neuralgia and healthy controls. Ann Med Res. 2021;28(4):704-708. doi: 10.5455/annalsmedres.2020.05.437
16. Tuncer Z, Akbulut N, Ekmek&ccedil;i UC, &Ccedil;irkinoğlu GG, &Ouml;zt&uuml;rk V, Erkin Y. Monocyte to high-density lipoprotein ratio and neutrophil to lymphocyte ratio in trigeminal neuralgia patients: a retrospective cohort study: MHR and NLR in trigeminal neuralgia. J Surg Med. 2023; 7(9):568-573. doi.org/10.28982/josam.7884
17. Wahlund LO, Barkhof F, Fazekas F, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001; 32(6):1318-22. doi:10.1161/01.str.32.6.1318
18. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-845. doi.org/10. 2307/2531595
19. Demartini C, Greco R, Zanaboni AM, et al. Antagonism of transient receptor potential ankyrin type-1 channels as a potential target for the treatment of trigeminal neuropathic pain: study in an animal model. Int J Mol Sci. 2018;19(11):3320. doi:10.3390/ijms19113320
20. Lu ZY, Fan J, Yu LH, Ma B, Cheng LM. The up-regulation of TNF-alpha maintains trigeminal neuralgia by modulating MAPKs phosphorylation and BKCa channels in trigeminal nucleus caudalis. Front Cell Neurosci. 2021;15:764141. doi:10.3389/fncel.2021.764141
21. Zhang ZJ, Dong YL, Lu Y, Cao S, Zhao ZQ, Gao YJ. Chemokine CCL2 and its receptor CCR2 in the medullary dorsal horn are involved in trigeminal neuropathic pain. J Neuroinflammation. 2012;9:136. doi:10. 1186/1742-2094-9-136
22. Liu MX, Zhong J, Xia L, Dou NN, Li ST. A correlative analysis between inflammatory cytokines and trigeminal neuralgia or hemifacial spasm. Neurol Res. 2019;41(4):335-340. doi:10.1080/01616412.2018.1564188
23. Trevisan G, Benemei S, Materazzi S, et al. TRPA1 mediates trigeminal neuropathic pain in mice downstream of monocytes/macrophages and oxidative stress. Brain. 2016;139(Pt 5):1361-1377. doi:10.1093/brain/aww038
24. Tecchio C, Micheletti A, Cassatella MA. Neutrophil-derived cytokines: facts beyond expression. Front Immunol. 2014;5:508. doi:10.3389/fimmu.2014.00508
25. Algul FE, Unver FB. Relationship between trigeminal neuralgia and the C-reactive protein/albumin ratio. Turk J Neurol. 2024;30(3):134-140. doi:10.55697/tnd.2024.134
26. Lai S, Li H, Xing Y, Wu D, Wang L, Liang Q. Exploring the role of inflammatory biomarkers in trigeminal neuralgia.Brain Behav Immun Health. 2024;43:100930. doi:10.1016/j.bbih.2024.100930
27. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2): 119-177. doi:10.1093/eurheartj/ehx393
28. Chen F, Chao M, Huang T, et al. The role of preoperative inflammatory markers in patients with central nervous system tumors, focus on glioma. Front Oncol. 2022;12:1055783. doi:10.3389/fonc.2022.1055783
29. Liu Y, Tanaka E. Pathogenesis, diagnosis, and management of trigeminal neuralgia: a narrative review. J Clin Med. 2025;14(2):528. doi:10.3390/jcm14020528
30. Lee GW, Son JY, Lee AR, Ju JS, Bae YC, Ahn DK. Central VEGF-A pathway plays a key role in the development of trigeminal neuropathic pain in rats. Mol Pain. 2019;15:1744806919872602. doi:10.1177/1744806919872602
31. Patil S, Testarelli L. Assessment of growth factors, cytokines, and cellular markers in saliva of patients with trigeminal neuralgia. Molecules. 2021;26(10):2964. doi:10.3390/molecules26102964
32. Liu Y, Li J, Butzkueven H, et al. Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics. Eur J Radiol. 2013;82(5):783-786. doi:10.1016/ j.ejrad.2012.11.027
33. Wang Y, Li D, Bao F, Guo C, Ma S, Zhang M. Microstructural abnormalities of the trigeminal nerve correlate with pain severity and concomitant emotional dysfunctions in idiopathic trigeminal neuralgia: a randomized, prospective, double-blind study. Magn Reson Imag. 2016;34(5):609-616. doi:10.1016/j.mri.2015.11.013
34. DeSouza DD, Hodaie M, Davis KD. Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia. Pain. 2014;155(1):37-44. doi:10.1016/j.pain.2013.08.029
35. Wu M, Jiang X, Qiu J, Fu X, Niu C. Gray and white matter abnormalities in primary trigeminal neuralgia with and without neurovascular compression. J Headache Pain. 2020;21(1):136. doi:10.1186/s10194-020-01205-3
36. Moayedi M, Hodaie M. Trigeminal nerve and white matter brain abnormalities in chronic orofacial pain disorders. Pain Rep. 2019;4(4): e755. doi:10.1097/PR9.0000000000000755
37. Liu J, Zhu J, Yuan F, Zhang X, Zhang Q. Abnormal brain white matter in patients with right trigeminal neuralgia: a diffusion tensor imaging study. J Headache Pain. 2018;19(1):46. doi:10.1186/s10194-018-0871-1
38. Chiang PL, Chen HL, Lu CH, et al. White matter damage and systemic inflammation in Parkinson&rsquo;s disease. BMC Neurosci. 2017;18(1):48. doi: 10.1186/s12868-017-0367-y
39. Miklossy J, Doudet DD, Schwab C, Yu S, McGeer EG, McGeer PL. Role of ICAM-1 in persisting inflammation in Parkinson disease and MPTP monkeys. Exp Neurol. 2006;197(2):275-283. doi:10.1016/j.expneurol. 2005.10.034
Article available in :
Volume 8, Issue 2, 2025
Page : 197-203
https://doi.org/10.32322/jhsm.1556900
Article Information
Received : 23 Eyl 2024
Accepted : 26 Oca 2025
Published : 21 Mar 2025
Corresponding Author :

Demet Aygün Üstel: Department of Neurology, Faculty of Medicine, İstanbul Atlas University, İstanbul, Turkiye

[email protected]
Citation : Aygün Üstel D, Doğu H. Evaluation of hematologic inflammation parameters and cranial magnetic resonance imaging findings in patients with trigeminal neuralgia. J Health Sci Med. 2025;8(2):197-203.

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