Trigeminal Neuralgia Flashcards
What is trigeminal neuralgia?
facial pain syndrome in distribution of 1 or more division of trigeminal nerve
What are common triggers for trigeminal neuralgia?
- Washing affected area
- Shaving
- Eating
- Talking
- Dental prostheses
What is the common epid for trigeminal neuralgia?
- Female/Male (Asian 2:1)
2. Over 50
What are RF for trigeminal neuralgia?
- MS
2. Increased age
What are secondary causes of trigeminal neuralgia?
- Compression of TN by intracranial vessels or tumour
- Chronic meningeal inflammation
- MS
- Zoster
- Skull base malformation e.g. chiari
What are the symptoms and signs of trigeminal neuralgia?
- Intense stabbing pain
- Lasting seconds in trigeminal nerve area – up to 2 mins
- Unilateral
- Affect mandibular and maxillary divisions
- Asymptomatic between episodes
What are possible DDx for trigeminal neuralgia?
- Dental caries
- Dental fracture
- Mandibular osteomyelitis
- TMJ syndrome
- Migraine
- Glossopharyngeal neuralgia
Etc
What investigations are used for trigeminal neuralgia?
clinical diagnosis
What is the acute treatment for trigeminal neuralgia?
1st line: anticonvulsants e.g. carbamazepine 100mg/12h (ideal), lamotrigine, phenytoin, gabapentin
What is the management of trigeminal neuralgia when anticonvulsant is unresponsive?
baclofen
What is the 1st line treatment for Type 1 TN when ongoing medicine unresponsive?
microvascular decompression
What is the 1st line treatment for Type 1/2 TN when ongoing medicine unresponsive?
ablative surgery: e.g. stereotactic gamma knife surgery
What is the 1st line treatment of TN when surgical and medical failure?
neurostimulation
What is possible complication of TN?
Post-op complication e.g. hearing loss or facial hypaesthesia
What is the prognosis of TN?
usually relapse over time
