Trigeminal Neuralgia

Question 1

Subtypes

Answer 1

Idiopathic
Primary - trigeminal nerve compression
Secondary - organic disease such as tumour of trigeminal nerve, MS/demyelination, cerebral neoplasms, lesions affecting trigeminal nerve at the cerebellopontine angle

Question 2

Diagnosis

Answer 2

Neurological assessment (negative)
May identify trigger areas on exam otherwise NAD
SI: MRI brain, MR angiography, trial carbamazepine

Question 3

Management

Answer 3

Carbamazepine 100mg bd for 2 weeks
Increased to 100mg tds if no pain control achieved
Can be increased up to 1200mg/day
Medical management successful in 80% cases
Monitor blood pressure, U&E, LFT, FBC, Folate

Question 4

Surgical management

Answer 4

Peripheral surgery: cryosurgery of affected branch
Intracranial surgery: micro vascular decompression (gold standard)
Percutaneous surgery: radio frequency lesioning risk of numbness and pain (anaesthesia Dolorosa)
Sclerotic gamma knife radio surgery

Question 5

Symptoms

Answer 5

Sudden sharp severe stabbing pain
Lasts few seconds to <2mins
Attacks more common in morning 
Unilateral, affecting one branch of CNV
No night wakening
Quality of life severely affected
Attacks may be brought on by cold air, touch, shaving