Trigeminal Neuralgia Flashcards
risk factors for trigeminal neuralgia?
-3
Older age
Female
MS
which autoimmune disease increases risk of tri neuralgia by 20x?
MS
which trigeminal pathway does tears?
V1
autonomic symptoms of trigeminal neuralgia?
Lacrimation
Facial swelling
Rhinorrhoea
Ptosis
main symptom of trigeminal neuralgia?
severe unilateral pain
how long does pain last for?
Seconds to minutes
what sensation might pt feel across face?
Electric shock like sensation
main sign on examination?
-1
Pain on touch - allodynia
what category of diagnosis is this?
Clinical
pathophysiology of trigeminal neuralgia?
Trigeminal nerve is being compressed –> causing aberrant conduction along the trigeminal nerve –> produces neuropathic pain
what triggers the pain?
give e.g.?
-3
light touch
shaving, talking, washing.
in trigeminal neuralgia the trigeminal nerve is being compressed.
what is causing this compression?
vessel compressing it
which blood vessel commonly compresses on the trigeminal nerve?
what else can cause a vessel to pathologically compresses on the trigeminal nerve?
-2
superior cerebellar artery
aneurysms or AV malformation
is it theorised that compression on trigeminal nerve change the nerve’s structure, in what way?
removes myelin
Red Flag Symptoms for trigeminal neuralgia?
-7
Onset <40 years Pain only in ophthalmic division Optic neuritis Deafness Sensory changes Skin or oral lesions FHx of MS
1st line drug for trigeminal neuralgia?
- name
- group
Carbamazepine
anticonvulsant
1st line drug for trigeminal neuralgia that is also used in epilepsy?
Carbamazepine
1st line drug for trigeminal neuralgia?
-name
if this drug does not work what is 2nd line Mx?
-2 types
Carbamazepine
Surgery -microvascular decompression or ablative surgery
Carbamazepine moa?
Carbamazepine two main uses?
Na+ channel blocker
seizures and neuropathic pain
describe how microvascular decompression is done?
nerve and vessel separated, sponge placed between them
Thermorhizotomy is used to ablate the trigeminal nerve.
what is Thermorhizotomy?
incinerate nerve
Cryotherapy is used to ablate the trigeminal nerve.
what is cryotherapy?
freeze nerve
Glycerol injection is used to ablate the trigeminal nerve.
how does this work?
deposit glycerol which is a corrosive chemical, so it destroys the nerve.
Balloon compression is used to ablate the trigeminal nerve.
what is balloon compression?
inflated balloon compresses & damages nerve.
Stereotactic radiosurgery is used to ablate the trigeminal nerve.
what is stereotactic radiosurgery
use radiation to the destroy nerve
which virus if it infects face can cause trigeminal neuralgia?
herpes zoster
