Neurology

Question 1

Burning mouth syndrome: description

Answer 1

Intraoral burning sensation without medical or dental explanation

Question 2

Burning mouth syndrome: epidemiology

Answer 2

Postmenopausal women, one study >80 years—anxiety and depression may contribute

Question 3

Burning mouth syndrome: etiology

Answer 3

Idiopathic—proposed to be trigeminal small fiber neuralgia or possibly 2/2 increase unoccupied D2 dopamine receptors in putamen

Question 4

Burning mouth syndrome: diagnosis

Answer 4

ICHD3: All required

1. Oral pain
2. Recurs daily >2hours x >3 months
3. Burning AND superficial qualities
4. Oral mucosa normal + normal sensory testing
5. Not better explained by another ICHD3 Dx

Question 5

Burning mouth syndrome: management

Answer 5

Tricyclic antidepressants Clonazepam Gabapentin Alpha-lipoic acid Pramipexole (anti-Parkinson’s dopamine agonist)

Question 6

Trigeminal neuralgia: branches affected

Answer 6

1. Ophthalmic
2. Maxillary
3. Mandibular

Question 7

Trigeminal neuralgia: description

Answer 7

Recurrent, brief unilateral electric shock-like pains, sudden onset and resolution affecting one or more branches of CNV. Triggers typically innocuous.

Question 8

Trigeminal neuralgia: epidemiology

Answer 8

1. Rare 4 per 100k/year
2. Female>Men
3. >50 years, incidence increasing with age
4. Rarely in 20s, 30s
5. Risks: HTN and migraine?

Question 9

Trigeminal neuralgia: etiology

Answer 9

1. Compression of CNV nerve root as it enters pons– usually by vein or arterial loop
2. Compression leads to symptoms 2/2 demylination of affected portion of CNV
3. Less commonly caused by vestibular schwannoma, meningioma, AVM, others

Question 10

Trigeminal neuralgia: diagnosis

Answer 10

1. Recurrent paroxysmal unilateral facial pain limited to CNV branch(es)
2. Pain lasting fractions of seconds to 2 minutes, severe, shock-like, stabbing, shooting, sharp
3. Triggered by innocuous stimuli
4. Not better account for by another ICHD3 Dx

MRI recommended wwo contrast to r/o neurovascular compression or structural abnormality

Question 11

Trigeminal neuralgia: subtypes (3)

Answer 11

1. Classic TN- no apparent cause other than neurovascular compression–requiring MRI confirmation of CNV pathology
2. Secondary TN- 2/2 underlying disease e.g. MS, tumor, AVM
3. Idiopathic TN- No findings on MRI or electrophysiological testing (10%)

Question 12

Trigeminal neuralgia: management

Answer 12

1. Carbamazepine or oxcarbazepine (1st line)
2. Gabapentin
3. Lamotrigine
4. botox, pregabalin, baclofen, phenytoin, topiramate as adjuncts or monotherapy