Functional Neurosurgery - ENC

Question 1

What are the three pathophsyiological types of chronic pain?

Answer 1

1. Nociceptive pain from noxious stimuli of intact tissues.
2. Neuropathic pain.
3. Central pain from damage to CNS structures.

Question 2

What fiber types conduct nociceptivce pain impulses?

Answer 2

1. A-delta fibers (myelinated).

2. C-fibers (unmyelinated).

Question 3

What pain types and qualities of pain signals are mediated by A-delta fibers and C-fibers?

Answer 3

1. A-delta fibers: “first pain”, prickly sensation.

2. C-fibers: “second pain”, slow onset, poorly localized, burning pain.

Question 4

What neuronal structure has been implicated in the pathophysiology of chronic cluster headaches?

Answer 4

1. Posterior hypothalamus.

Question 5

What is a minimally invasive treatment for chronic cluster headaches?

Answer 5

1. Sphenopalatine ganglion blockade with local anesthetics.

Question 6

5 cardinal features of idiopathic typical trigeminal neuralgia?

Answer 6

1. Pain that is paroxsymal.
2. Pain that is provocable.
3. Pain that is unilateral.
4. Pain that is confied to the trigeminal territory.
5. Intact light touch or pinprick sensation.

Question 7

What are more common characteristics of atypical facial pain?

Answer 7

1. Pain is often bilateral.
2. Constant pain.
3. Pain not provoked by external stimuli.

Question 8

For which reflexes does the trigeminal nerve provide afferent signal conduction?

Answer 8

1. Corneal reflex (V1 afferents to CN VII efferents).

2. Sternutatory reflex (sneezing).

Question 9

What are the neuronal pathways of trigeminal-mediated sensation?

Answer 9

1. Light touch fibers ascend to terminate in the chief sensory nucleus of CN V.
2. Pain/temp fibers descend to terminate in the nucleus of the spinal tract of CN V.
3. Fibers transmitting jaw proprioception terminate in the mesencephalic nucleus.

Question 10

What is the drug of choice in the medial treatment of trigeminal neuralgia?

Answer 10

1. Tegretol (carbamazepine).