Idiopathic

Question 1

What is the most common population with Trigeminal Neuralgia?

Answer 1

elderly but can happen in the young

Question 2

What is the etiology of Trigem neuralgia?

Answer 2

mechanical compresion of CN V nerve root
or
demylination plaques due to MS

Question 3

What artery is most likely pathophysiologically at fault in Trigem Neuralgia?

Answer 3

Superio Cerebellar artery compress CN V root

Question 4

What is the pathophysiology for Trigeminal Neuralgia?

Answer 4

peripheral sensory neurons of Trigem ganglia affected or central sensitization of Spinal trigeminal nucleus (espeically in final syndrome)

Question 5

What is the presentation of trigeminal neuralgia

Answer 5

1) abrupt onset
2) electric shock, stabbing pain in regions of face
3) unilateral, rarely Bilateral
4) triggers can be area outside of area of pain, nonnoxious stimuli, cervical region triggers

Question 6

What is the etiology of Trigeminal neuralgai?

Answer 6

idiopathic. some suggest familial but likely mulitfactorial compression or irritation of CN V root or ganglion

Question 7

What is the etiology of Complex regional pain syndrome (causalgia)?

Answer 7

idiopathic often associated with post-trauma

Question 8

What increases the liklihood of getting Complex regional pain syndrome?

Answer 8

sciatic nerve damage or distal nerve lesion
women are 3x as likely as men
mean age is early 40’s

Question 9

What is the most common event that preceeds CRPS?

Answer 9

trauma 77% (sprain then post surgery then crush or compression)
-colles fracture, peripheral nerve lesion, sciatic nerve damage

Question 10

What are some suggested pathologies for CRPS?

Answer 10

abberant healing, exaggerated inflammatory process, protective disuse, dysfunctional nervous system, myofascial, CNS abnormalities

Question 11

What is the presentation for CRPS?

Answer 11

Can progress in 3 stages. Most cases present with burning pain and paresis, skin temperature and color change, limited ROM, hyperpathy, hyperesthesia, hypoesthesia, edema, alter hair and nail growth

Question 12

What is the presentation of stage 1 CRPS?

Answer 12

acute onset after 1 month of trauma
1) ache, burn pain aggravated by touch or emotion
2) bony pain and allodynia is possible
last 3 months post injury

Question 13

What is the presentation of stage 2 CRPS?

Answer 13

dystrophic
1)spontaneous radiating burning pain
2) hyperpahty
3) trophic change to hair, skin
3-6 months post trauma

Question 14

What is the presentation of stage 3 CRPS?

Answer 14

Atrophic
1) diminishing pain
2)cooling skin
3) subcutaneous atrophy and wasting
6-12 months post trauma

Question 15

What is the treatment for CRPS?

Answer 15

NSAID, corticosteriods
Sympathetic blockage, placebo block
Gabapentin, clondine
TCA’s
Ca channel blockers, beta blockers, calcitonin
Surgical ablation and dorsal column stimulation

Question 16

What is the prevention for CRPS?

Answer 16

diagnose early before it progresses to later stages

Question 17

What are the diagnostics for CRPS?

Answer 17

History and physical #1
x-ray and bone scan for demineralization
thermography
autonomic testing

Question 18

What are the diagnostics for Trigeminal neuralgia?

Answer 18

1 history and physical to rule out other facial structural problems (sinus problems)

Question 19

What is the treatment for Trigeminal neuralgia?

Answer 19

Pharmaceuticals, anticonvulsants, antispasticity
local anesthetic
surgery to decompress
surgery neurectomy or gangliolysis
radiosurg with gamma knife