Trigeminal neuralgia

Question 1

trigeminal neuralgia is

Answer 1

pain that is unilateral and localized to the maxillary and mandibular branches of trigeminal nerve.

see brief shock-like electric pain and lasting seconds to minutes

can affect the maxillary and mandibular branches

will NOT have difficulty chewing (myasthenia gravis) or pain in jaw (temporal arteritis)

Question 2

most common and most intense cranial neuralgia

Answer 2

trigeminal neuralgia

seen with MS pts

Question 3

presentation of paroxysmals of trigeminal neuralgia

Answer 3

can be spontaneously triggered or by innocuous stimulation of face

refractory periods are common after series of paroxysms

ipsilateral autnomic features are rare

Question 4

best way to diagnosis trigeminal neuralgia

Answer 4

neuro exam is normal

but must get MRI of brain to rule out MS.

contrast enhanced brain MRI detects nonvascular structure patholoyg (compressing and demyelinating in 15% of

• Brain MRA will detect neurovascular contract between the loop of the superior cerebellar artery and trigeminal nerve

Question 5

management of trigeminal neuralgia is

Answer 5

1st line carbamazepines

2nd line is oxcarbazepine, baclofen, gabapentin, and lamotrigene

non surgical options: gamma knife (sterotatic focused radiation) or
percutanteous radiofrequency coagulation glycerol injection

surgery: posterior fossa microvascular decompression of the neurovascular contact zone is more invasive and more effective.

Question 6

when do pts with trigeminal neuralgia start to feel better after starting a medication?

Answer 6

within a few days

can have hyponatremia and agranulocytosis

Question 7

what is a dreaded side effect of carbamazepine

Answer 7

can have hyponatremia and agranulocytosis

also can TEN and SJS

Question 8

what is seen on MRI with trigeminal neuralgia

Answer 8

can see demyelinating plaques in the pontine entry of the trimgeinal root

Question 9

what is chronic paroxsymal hemicrania and how is this treated?

Answer 9

this is another trigeminal cephalalgias

affects the ophthalmic branch of trigeminal nerve - see pain localized to orbital or supraorbital or temporal areas

Question 10

Treatment of chronic paroxysmal hemicrania

Answer 10

indomethacin

Question 11

chronic paroxysmal hemicrania presentation

Answer 11

these episodes last 2-30 minutes and reoccur about 40 a day. See ipsilateral cranial autonomic features present and attacks are precipitated by the cervical spine rotation and or compression but not facial stimulation.

Question 12

short lasting unilateral neuralgiform headache is seen with

Answer 12

conjunctival injection and tearing

another type of headache.

refractory to medical management

Question 13

short lasting unilateral neuralgiform headache presentation

Answer 13

can last 1 to 600 seconds and can reoccur about 100X a day

Involves the ophthalmic branch of trigeminal nerve and includes ipsilateral autonomic features like conjunctival injection and tearing.

Question 14

why do we get MRI when we are considering trigeminal neuralgia?

Answer 14

to rule out multiple sclerosis

Question 15

carbamazepine can cause

Answer 15

neutropenia

hyponatremia