Ch. 18 - Facial pain and hemifacial spasm Flashcards Preview

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Flashcards in Ch. 18 - Facial pain and hemifacial spasm Deck (20)
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What is trigeminal neuralgia?

Excruciating paroxysmal pain in CN5 distribution; AKA 'tic douloureux'


Etiology of trigeminal neuralgia

Microvascular compression theory (vascular loop at brainstem junction); associated with MS; less likely from tumor compression or AVM in posterior fossa


Clinical features of trigeminal neuralgia

Sudden, severe pain lasting for seconds; can be triggered by anything (e.g. moving one specific hair in moustache); limited to one branch of CN5


What CN5 branches are most commonly affected in trigeminal neuralgia?

V2 +/- V3


How does trigeminal neuralgia in patients with MS differ?

Often occurs bilaterally


What is the nerve function abnormality in trigeminal neuralgia?

NO detectable abnormality of nerve function


Why get an MRI in trigeminal neuralgia?

Exclude mass in cerebellopontine angle in posterior fossa or intrinsic brainstem lesion (e.g. demyelination)


DDx of trigeminal neuralgia

Atypical facial pain, dental pain, TMJ, postherpetic neuralgia, migrainous neuralgia (i.e. cluster HA)


Medical tx options for trigeminal neuralgia

Carbamazepine is 1st line but often causes intolerable side effects (e.g. dizziness, n/v)


Surgical tx of choice for elderly, frail patient with trigeminal neuralgia

Infraorbital or supraorbital nerve section if pain localized to these distributions


Describe percutaneous thermocoagulation (i.e. rhizotomy) for tx of trigeminal neuralgia. Complications?

Needle passed percutaneously through foramen ovale into ganglion and nerve roots (behind Meckle's cave) then heated or bathed in glycerol; complications include facial numbness and frequent recurrence


Describe the posterior fossa craniotomy procedures available for tx of trigeminal neuralgia. Complications?

Trigeminal nerve section - causes facial numbness and possibly 'anesthesia dolorosa'

Microvascular decompression (superior cerebellar artery dissected away) - best results but some relapse occurs


What is the preferred surgical tx for trigeminal neuralgia?

Microvascular decompression - greatest chance of producing permanent relief with no facial numbness


What is glossopharyngeal neuralgia?

Intense attacks of pain in distribution of glossopharyngeal and auricular + pharyngeal branches of trigeminal nerve (throat, tongue, ear)


Tx for glossopharyngeal neuralgia

Carbamazepine (less success than for trigeminal neuralgia); surgery is very effective (section of CN9 and upper part of CN10)


What is postherpetic neuralgia?

Burning pain after herpes zoster in distribution of trigeminal nerve (V1 most common)


Tx of postherpetic neuralgia

No surgical tx; early use of steroids and acyclovir in patients with herpes zoster may reduce risk


What is atypical facial pain?

Facial pain without pathologic basis, most frequently affects middle-aged females


What is hemifacial spasm?

Unilateral spasm of facial muscles supplied by CN7; proposed etiology is similar to trigeminal neuralgia (nerve compression) with same tx (microvascular decompression)


What is 'tic convulsif'?

Coexisting hemifacial spasm and trigeminal neuralgia