Episodic Neuropathic Pain (B)

Question 1

Glossopharyngeal Neuralgia (GN)

Answer 1

• Aka: Vagoglossopharyngeal neuralgia
• rare
• Men > Women
• affects the throat or periauricular area
  
  • Auricular Branch of Vagus
  • Pharyngeal Branch of Vagus
  • Glossopharyngeal Nerve
• Low recurrence rate (⅔ have 1 attack only)
• Triggers:
  
  • sneezing, coughing, swallowing
  • anything that contacts pharynx/larynx
• 2 forms:
  
  • Pharyngeal:
    
    • Pain in pharynx, tonsil, soft palate, posterior tongue, inner ear, angle of mandible
    • radiate to eye, nose, shoulder
  • Tympanic
    
    • Pain in ear
      
      • radiates to pharynx
• Associated with:
  
  • syncope
  • arrhythmias
  • MS
• Tx:
  
  • pacemaker
  • Anti-Convulsants
  • Surgical:
    
    • MVD
    • GKS

Question 2

Occipital Neuralgia

Answer 2

• Etiology:
  
  • trauma to occipital nerve
  • Infection
  • Nerve compression
• Pain on back of head/neck
• Blurred vision, lacrimation, dizzy, tinnitus
• Tx:
  
  • PT
  • long acting corticosteroids

Question 3

Nervus Intermedius Neuralgia

Answer 3

• aka geniculate neuralgia
• Pain deep in ear
• Ramsay Hunt Syndrome
  
  • NIN
  • Herpes Zoster Virus
  • Facial Palsy
• Tx:
  
  • anticonvulsants
  • Excise nevus intermedius & geniculate ganglion

Question 4

Superior Laryngeal Neuralgia

Answer 4

• Pain in:
  
  • throat
  • submandibular region
  • under ear
• Trigger by:
  
  • swallowing
  • straining voice
  • Turning head
• Tx:
  
  • anti-convulsants
  • Nerve block

Question 5

Trigeminal Neuralgia

Answer 5

• Intense stabbing, shock-like pain
  
  • Paroxysmal episodes
• Lasts a few weeks/months→ remission
  
  • Refractory period: time b/w attacks when nerves do not fire
• Unilateral
• Trigger points:
  
  • Cutaneous corners of lips
  • cheeks
  • ala of nose
  • lateral brow
  • gingiva
• Classification:
  
  • Symptomatic
    
    • Clear cause
  • Essential/Idiopathic
    
    • unclear cause
• Tx:
  
  • Anticonvulsant drugs
  • Surgery→if drugs down work
    
    • Microvascular depresssion
    • percutaneous prcoedures
    • gammna knife

Question 6

Acute Herpes Zoster (HZ)

Answer 6

• Aka Shingles
• Latent varicella virus is reactivated
• Acute herpes:
  
  • Prodrome: (Begins with)
    
    • pain
    • Headache
    • itching
    • malaise
• Location:
  
  • Thoracic > Lumbar
• Vesicles & pain:
  
  • dermatomal
  • unilateral
  • appear when maxillary/mandibular branch of trigeminal N. is affected (2-28%)
    
    • Ophthalmic=80%
• Tx:
  
  • Antivirals
  • Tylenol
  • Amitryptiline
  • Vaccinate Elderly

Question 7

Postherpectic Trigeminal Neuralgia (PHN)

Answer 7

• Acute HZ pain becomes PHN
  
  • 1-6 months after lesion crests
• Very painful

Question 8

Painful Traumatic Trigeminal Neuropathy (PTTN)

Answer 8

• aka persistent dentoalveolar pain
  
  • continuous neuropathic pian
• Head Neck Trauma→onset of pain
  
  • Endo
  • 3rd molar ext
  • nerve blocks
  • orthographic surgery-most common
• Reoccurs daily
  
  • > 2 hours
• Present >3 months

Question 9

Myospasm

Answer 9

• reversible muscle contraction
  
  • sudden
  • involuntary
• Sudden onset of:
  
  • restricted jaw movement
  • muscle rigidity

Question 10

Dystonia

Answer 10

• Sudden uncontrolled muscle contraction
  
  • myospasm repeats
• Generalized dystonia
  
  • many muscles groups
• Focal dystonia
  
  • specific muscles or muscle groups

Question 11

Oromandibular Dystonia

Answer 11

• Focal Dystonia
  
  • repeated/sustained muscles spasms in:
    
    • masticatory m
    • facial m
    • lingual m.
• Caused Involuntary painful jaw:
  
  • opening
  • closing
  • protruding
  • combo
• Etiology:
  
  • idiopathic
  • drug induced
• Clinical