Trigeminal neuralgia

Trigeminal neuralgia
👉 > 50. F > M.
👉 5th CN : facial sensory / motor
👉Trigeminal neuralgia: Sudden,severe stabbing/ jabbing / lancinating / electric shock like pain,
👉2, 3rd div, Unilateral, lasting seconds to few minutes. Multiple episodes lasting for hours.
👉Aggravated by any touch, cold wind draft, jaw movement.
👉 Causes: 80% SCA superior cerebellar a wrapped around the nerve exiting the brain stem. Others : Dental abscess, TMJ, strokes, multiple sclerosis, trauma, tumor, AV malformation, Temporal arthritis, post herpetic neuralgia, glossopharyngeal neuralgia.
Meds: carbamazepine, ox carbamazepine, Baclofen, Lamotrigine, Phenytoin, gabapentin, Pregablin, amitriptyline, Pimozide, Clonazepine, Lidocaine, Duloxetine,
✂️Surgical option if meds failed:
👉Microvascular decompression : 75% effective, complicated with facial numbness. Prevents further myelin sheath damage.
👉Radiofrequency thermocoagulation Rhizotomy: damage the nerve. No GA gen anesthesia needed.
👉Steriotactic radiosurgery: focal radiation therapy. No GA needed.
👉Percutaneous needle / catheter : damaging area where nerve branches. Done in elderly, poor surgical candidate.
👉Baloon compression: inflating damaging the nerve.
👉Glycerol injection.


🔲 1 out of 4
🟨 Hyperesthesia / Allodynia
🟨 Vasomotor: Temperature / skin color asymmetric changes
🟨 Sudomotor: asymmetric edema/ sweating changes
🟨 Motor / trophic changes: weakness, dystonia, tremors / skin, hair, nail
🔲 Involve distal part of limbs but not head / trunk
🔲 Does not involve particular nerve or nerve root
🔲 Triple phase bone scan showing ipsilaterally active bone resorption within 5 months. Compare both sides! increased localized biphosphonate tracer uptake. Diffuse joint involvement r/o inf / arthralgias)



S/S: Mild s/s in healthy adults, mild flu like s/s, swollen lymph nodes, during pregnancy: congenital toxoplasmosis. Headache, confusion, seizures hemiparesis, CN + brainstem involvement, hemiparesis, focal neurological symptoms, CD 4 count < 100 cells / mic L in people with AIDS. II Spread: poorly cooked food containing a spores, infested cat feces, infected mother & blood transfusion. Imaging: MRI: show Ring enhancing lesions in the white matter , basal ganglia, corticomedullary junction. Labs: + antibodies in serology amniotic fluid or positive CSF polymerase chain reaction. Rx : 👉🏿 Wash hands and wear gloves if you clean the cat litter. Cook meals well.