Trigeminal neuralgia

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.
💊Medical:
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.

Thalamic pain syndrome

Central pain syndrome

Lacunar stroke
Involves ventrocaudal thalamic area
Contralateral sensory loss
Face, arms, leg
All sensory modalities
Later lead to long term chronic central Thalamic pain
Severe pain in paroxysms or exacerbated by touch
Rx: amitriptyline, Lamotrigine, Mexiletine, gabapentin, Pregablin, Lidocaine.
Opioids are not effective.

Epilepsy Triggers

Epilepsy triggers

If you comply with the medication, eat right, sleep right and avoid the stress you can prevent seizures. To prevent seizures one need to be a pastor, priest nun or a cadet, what is common among them is that they go to bed at right time, sleep at right time, eat right time and everything they do is by the book. If you have consistency in your life you will prevent most of the seizures. And you need to avoid the stress as well to prevent seizures. Cmply wit meds.

Delivering bad news

Delivering bad news

👉🏿Privacy: private room or private place.👉🏿Prepare yourself review the history and the testing👉🏿 No disturbances👉🏿 All are in …

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