Trigeminal neuralgia

Question 1

Trigeminal neuralgia “tic douloureux” Patho

Answer 1

• Cranial nerve 5
• Condition of the fifth cranial nerve characterized by paroxysms of pain
• Most commonly occurs in the second and third branches of this nerve.
• Vascular compression and pressure is the probable cause
• women Ages 50-70 / persons with MS
• Coexistence with MS. Thought to be caused by demyelination of axons in the ganglion, root, and nerve.

Question 2

Trigeminal neuralgia S/S

Answer 2

• Pain can occur with any stimulation such as washing face, brushing teeth, eating, or a draft of air
• Patients may avoid eating, neglect hygiene, and even isolate themselves to prevent attacks
• Trigeminal neuralgia is characterized by paroxysms of sudden pain in the area innervated by any of the three tranches of the nerve.
• The pain ends as abruptly as it starts and is described as a unilateral shooting and stabbing or burning sensation.
• Associated involuntary contraction of the facial muscles can cause sudden closing of the eye or twitching of the mouth (tic douloureux- painful twitch).

Question 3

Trigeminal neuralgia Nursing Interventions

Answer 3

• Patient education related to pain prevention and treatment regimen
• Measures to reduce and prevent pain; avoidance of triggers
  — such as food that is too hot or cold; brushing teeth
• Care of the patient experiencing chronic pain
  — can lead to depression as nothing looks like anything is wrong but the patient is experiencing terrible pain
• Measures to maintain hygiene: washing face, oral care
• Strategies to ensure nutrition; soft food, chew on unaffected side, avoid hot and cold food
• Recognize and provide interventions to address anxiety, depression, and insomnia
• wash face/ brush teeth softly

Question 4

Trigeminal neuralgia Medical Management

Answer 4

• Anticonvulsant agents, such as carbamazepine (Tegretol)
  — relieve pain in most patients with trigeminal neuralgia by reducing the transmission of impulses at certain nerve terminals.
  — taken with meals.
  — Serum levels must be monitored to avoid toxicity in patients who require high doses to control the pain.
  — Side effects include nausea, dizziness, drowsiness, and aplastic anemia.
  — Decrease nerve transmission (Tegretol, Dilantin)
  — Decrease pain (Gabapentin, Baclofan)
• corticosteroids- inflammation

Question 5

Trigeminal neuralgia SURGICAL TREATMENT

Answer 5

• is designed to either decompress the nerve and save nerve function or to damage the nerve and destroy nerve function to keep it from malfunctioning.
• Microvascular Decompression of the Trigeminal Nerve
  — an intracranial approach to relieve the contact between the cerebral vessel and the trigeminal nerve root entry.
• Radiofrequency Thermal Coagulation-
  — Percutaneous radiofrequency produces a thermal lesion on the trigeminal nerve. As a result, dysesthesia of the face and loss of the corneal reflex may occur.
• Percutaneous balloon microcompression
  — disrupts large myelinated fibers in all three branches of the trigeminal nerve. After its placement, the balloon is filled with a contrast material for fluoroscopic identification. The balloon compresses the nerve root for 1 minute and provides microvascular decompression.