Trigeminal Neuralgia

Question 1

Define trigeminal neuralgia

Answer 1

A facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve.

It is characterised by paroxysms of sharp, stabbing, intense pain lasting up to 2 minutes and/or a constant component of facial pain, without associated neurological deficit.

Question 2

What are the causes/risk factors of trigeminal neuralgia?

Answer 2

• Associated with trigeminal nerve compression in the majority of patients.
• Compression: 80% to 90% of patients have demonstrable focal compression of the trigeminal nerve root at the root entry zone by an aberrant vascular loop (typically the superior cerebellar artery). 
•  MS
• Other brainstem lesions: Brainstem infarcts and amyloid or calcium deposition along the trigeminal sensory pathway. These are rare.

Question 3

What are the symptoms of trigeminal neuralgia?

Answer 3

• Unilateral paroxysms of facial pain lasting seconds to minutes in a distribution along ≥1 divisions of the trigeminal nerve.
• Most commonly affects the maxillary and mandibular divisions.
• The pain associated with TN is typically described as intense, sharp, superficial, stabbing or burning in quality.
• Triggers: tooth brushing, face washing, eating, cold, and touch are common.
• Most patients are asymptomatic between episodes.

Question 4

What are the signs of trigeminal neuralgia?

Answer 4

• unremarkable physical and neurological examination

Question 5

What investigations are carried out for trigeminal neuralgia?

Answer 5

no useful tests - diagnosis is clinical