Trigeminal neuralgia Flashcards
What is trigeminal neuralgia?
(neuralgia = severe shooting pain in nerve which occurs due to damage/irritated nerve)
Trigeminal neuralgia is a chronic neurological disorder characterized by severe shooting or stabbing pain in the distribution of one or more divisions of the trigeminal nerve, usually V2 division, often causing severe pain.
What are the risk factors for trigeminal neuralgia?
Risk Factors → increased age & multiple sclerosis
Associated with herpes simplex virus
What causes trigeminal neuralgia?
- Thought to be due to compression of the trigeminal nerve by a loop of artery or vein
- Secondary causes (5-10% of cases)
*Compression of the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour
*Chronic meningeal inflammation
*MS
*Zoster
*Skull base malformation
Summarise the epidemiology of trigeminal neuralgia
Peak incidence: 50-60 yrs
Prevalence increases with age
More common in FEMALES (2:1)
Some familial component
What are the presenting symptoms and signs of trigeminal neuralgia
- Sudden, unilateral, brief, stabbing pain in the distribution or one or more branches of the trigeminal nerve
- Recurrent
- Pain lasts from a few seconds to a couple of mins
- Periods of remission can vary
- Some experience preceding symptoms (e.g. numbness, tingling)
- Pain is described as being ‘shock-like’ – face screws up with pain
- Triggers:
- Vibration
- Skin contact – washing area, shaving
- Eating
- Talking
- Dental prostheses
- Brushing teeth
- Exposure to wind
What investigations are used to diagnose/ monitor trigeminal neuralgia?
- Diagnosis is CLINICAL
- MRI is necessary to exclude secondary causes
How is trigeminal neuralgia managed?
- Newly-Diagnosed → anticonvulsants (carbamazepine)
*Carbamazepine ⇒ can cause SIADH - If insufficient response to medical therapy (referral to neurology) → microvascular decompression
Describe the epidemiology of trigeminal neuralgia
F>M, peak incidence 60-70
