Trigeminal Neuralgia

Question 1

Define trigeminal neuralgia

Answer 1

Facial pain syndrome in distribution of at least one of the divisions of the trigeminal nerve.

Question 2

What are risk factors for trigeminal N

Answer 2

Increased age
Multiple sclerosis (20x more prevalent in this population
Female
Hypertension
Asian descent

Question 3

What are some triggers for Trigeminal N?

Answer 3

Washing affected area
Shaving
Eating
Talking
Dental prostheses

Question 4

What is the aetiology of trigeminal neuralgia?

Answer 4

Focal compression of nerve root at the root entry zone by aberrant vascular loop (superior cerebellar usually)

Question 5

What is classification of TN?

Answer 5

Classic - intracranial vascular compression 75%
Secondary - MS or tumour 15%
Idiopathic - 10%, no lesion

Question 6

What is a typical TN patient?

Answer 6

Paroxysms of sharp, stabbing, intense pain lasting 2 minutes and constant component of facial pain without neuro deficit.

Question 7

What is typical distribution of TN/

Answer 7

Usually mandibular or maxillary and unilateral.

Question 8

What is it called when face screws up with pain?

Answer 8

Tic Douloureux

Question 9

How is TN diagnosed?

Answer 9

Clinical diagnosis

Question 10

Why do you need an MRI?

Answer 10

Rule out secondary causes
Tumour, meningeal inflammation, NS, skull base malformation.

Question 11

What is treatment of TN/

Answer 11

Carbamazepine 200mg a day split.
Microvascular decompression.