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bds4 > Trigeminal neuralgia > Flashcards

Trigeminal neuralgia Flashcards

1
Q

What Neuralgia?

A
  • intense stabbing pain caused by irritation or damage to a nerve
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2
Q

What 3 nerves can be affected in cranial neuralgia?

A
  • Trigeminal
  • Glossopharyngeal and vagus
  • Occipital
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3
Q

What is the incidence of trigeminal neuralgia?

A

More females and elderly

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4
Q

What is the classical cause of trigeminal neuralgia?

A

Vascular compression of the trigeminal nerve

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5
Q

Trigeminal neuralgia can be secondary to some conditions , give 3 examples?

A
  • Multiple sclerosis
  • Space occupying lesion
  • AVM
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6
Q

Explain the main symptom of trigeminal neuralgia?

A

unilateral stabbing pain that may last 5-10 seconds

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7
Q

Which divisions of the trigeminal nerve are mostly affected by trigeminal neuralgia?

A
  • Maxillary and mandibular more affected than opthalmic
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8
Q

List 3 things that may trigger trigeminal neuralgia pain?

A
  • Touch
  • Cold and wind
  • Chewing
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9
Q

What are the 2 catagories of pain episodes of trigeminal neuralgia?

A
  • Single stabs
  • Each attach is a group of stabs
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10
Q

Other than sharp shooting pain , what other two things can this pain have?

A
  • Can affect more than one division and can be bilateral
  • Can have a burning component
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11
Q

2 characteristics of a typical trigeminal neuralgia patient?

A
  • Usually older patient
  • Mask-like face
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12
Q

What 3 red flags of trigeminal neuralgia?

A
  • younger patient (less than 40)
  • other cranial nerves lesions
  • sensory deficits in the facial region
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13
Q

What should you do if a patient presents with redflags ?

A
  • Test carnial nerves
  • Send patient for an MRI
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14
Q

What class of drugs is trigeminal neuralgia treated with?

A

Anticonvulsant

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15
Q

What are the 3 first line drugs to manage trigeminal neuralgia?

A
  • Carbamazepine
  • Oxcarbazepine
  • Lamotrigine
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16
Q

What are 3 second line drugs for trigeminal neuralgia?

A
  • Gabapentin
  • Pregabalin
  • Phenytoin
17
Q

When is trigeminal neuralgia more evident during the day?

A

in the morning

18
Q

What are 4 side effects of carbamazepine?

A
  • Blood dycrasias
  • Electrolyte imbalances
  • Neurological deficits
  • Paraesthesias
  • Liver toxicity
19
Q

In what 2 cases would you consider surgery for trigeminal neuralgia?

A
  • when approaching maximum tolerable medical management
  • in younger patient with significant drug use
20
Q

What is the preferred surgical treatment for trigeminal neuralgia?

A
  • microvascular decompression
21
Q

What 3 other surgeries can be carried out to manage trigeminal neuralgia other tham microvascular decompressoin?

A
  • Stereotactic radiosurgery - gamma knife
  • Destructive central procedures - balloon compression
  • Destructive peripheral neurectomies
22
Q

What can be 2 risks of complications after surgery?

A
  • Sensory loss - hearing and sensation
  • Motor deficits
23
Q

What group of disorders may be mistaken to be trigeminal neuralgia?

A

Painful trigeminal neuropathy

24
Q

What are 3 causes of painful trigeminal neuropathy?

A
  • Herpes Zoster Virus
  • Trauma ( pain can develop after 6 months of traumatic event)
  • Idiopathic
25
Q

What are 3 characteristics of painful trigeminal neuropathy?

A
  • Localised pain to one or more parts of the trigeminal neuralgia
  • Describes as pins and needles or burning
  • more commonly accompanied by sensory deficits or cutaneous allodynia
  • Continuous pain
26
Q

What is trigeminal autonomic cephalalgias?

A

Unilateral very severe head pain commonly affecting ophthalmic branch

27
Q

3 symptoms of trigeminal autonomic cephalalgias other than unilateral head pain?

A
  • Eyelid oedema
  • Ear fullness
  • Horner’s syndrome (Miosis and ptosis)
    These occur ipsilateral to the headache
28
Q

Give 2 examples of autonomic trigeminal cephalalgias?

A
  • Cluster headache
  • Paroxysmal hemicrania
29
Q

What a cluster headache?

A
  • An autonomic trigeminal cephalalgy affecting the opthalmic division of the trigeminal nerve causing severe unilateral pain in the orbital and temporal region mainly
  • Characterised by rapid onset and cessation
30
Q

How is cluster headache commonly described?

A

Suicide headache

31
Q

What can be a differential characteristics between migraines and TACs?

A
  • TAC patient is often restless and agitated during the attack
  • Migraine patients have photophobia and phonophobia
32
Q

How does the cluster headache Episodes present?

A

they present typically 1-3 months then remission for at least one month

33
Q

What can trigger a cluster headache during a bout?

A

Alcohol

34
Q

What is the key difference between cluster headache and paroxysmal hemicrania?

A

Cluster headache occur at the same time each day during an episode and an episode occurs at the same time each year

35
Q

What may trigger a paroxysmal hemicrania?

A
  • bending or rotating the head
36
Q

Give one attack abortive treatment for cluster headache?

A

Sumatriptan

37
Q

What drug can prevent cluster headache?

A

Topiramate

38
Q

What drug is used for paroxysmal hemicrania?

A

indomethacin

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