Trigeminal Neuralgia

Question 1

risk factors for trigeminal neuralgia?

-3

Answer 1

Older age
Female
MS

Question 2

which autoimmune disease increases risk of tri neuralgia by 20x?

Answer 2

MS

Question 3

which trigeminal pathway does tears?

Answer 3

V1

Question 4

autonomic symptoms of trigeminal neuralgia?

Answer 4

Lacrimation
Facial swelling
Rhinorrhoea
Ptosis

Question 5

main symptom of trigeminal neuralgia?

Answer 5

severe unilateral pain

Question 6

how long does pain last for?

Answer 6

Seconds to minutes

Question 7

what sensation might pt feel across face?

Answer 7

Electric shock like sensation

Question 8

main sign on examination?

-1

Answer 8

Pain on touch - allodynia

Question 9

what category of diagnosis is this?

Answer 9

Clinical

Question 10

pathophysiology of trigeminal neuralgia?

Answer 10

Trigeminal nerve is being compressed –> causing aberrant conduction along the trigeminal nerve –> produces neuropathic pain

Question 11

what triggers the pain?

give e.g.?
-3

Answer 11

light touch

shaving, talking, washing.

Question 12

in trigeminal neuralgia the trigeminal nerve is being compressed.

what is causing this compression?

Answer 12

vessel compressing it

Question 13

which blood vessel commonly compresses on the trigeminal nerve?

what else can cause a vessel to pathologically compresses on the trigeminal nerve?
-2

Answer 13

superior cerebellar artery

aneurysms or AV malformation

Question 14

is it theorised that compression on trigeminal nerve change the nerve’s structure, in what way?

Answer 14

removes myelin

Question 15

Red Flag Symptoms for trigeminal neuralgia?

-7

Answer 15

Onset <40 years 
Pain only in ophthalmic division 
Optic neuritis 
Deafness 
Sensory changes 
Skin or oral lesions 
FHx of MS

Question 16

1st line drug for trigeminal neuralgia?

• name
• group

Answer 16

Carbamazepine

anticonvulsant

Question 17

1st line drug for trigeminal neuralgia that is also used in epilepsy?

Answer 17

Carbamazepine

Question 18

1st line drug for trigeminal neuralgia?
-name

if this drug does not work what is 2nd line Mx?
-2 types

Answer 18

Carbamazepine

Surgery -microvascular decompression or ablative surgery

Question 19

Carbamazepine moa?

Carbamazepine two main uses?

Answer 19

Na+ channel blocker

seizures and neuropathic pain

Question 20

describe how microvascular decompression is done?

Answer 20

nerve and vessel separated, sponge placed between them

Question 21

Thermorhizotomy is used to ablate the trigeminal nerve.

what is Thermorhizotomy?

Answer 21

incinerate nerve

Question 22

Cryotherapy is used to ablate the trigeminal nerve.

what is cryotherapy?

Answer 22

freeze nerve

Question 23

Glycerol injection is used to ablate the trigeminal nerve.

how does this work?

Answer 23

deposit glycerol which is a corrosive chemical, so it destroys the nerve.

Question 24

Balloon compression is used to ablate the trigeminal nerve.

what is balloon compression?

Answer 24

inflated balloon compresses & damages nerve.

Question 25

Stereotactic radiosurgery is used to ablate the trigeminal nerve.

what is stereotactic radiosurgery

Answer 25

use radiation to the destroy nerve

Question 26

which virus if it infects face can cause trigeminal neuralgia?

Answer 26

herpes zoster