Trigeminal Neuralgia and Trigeminal Autonomic Cephalagias

Question 1

what is neuralgia?

Answer 1

a type of nerve pain (stabbing, sharp shooting)

usually brief, but severe

caused by irritation of/or damage to nerve

Question 2

what are some of the causes of trigeminal neualgia?

Answer 2

• idiopathic (no known cause)
• vascular compression of nerve
• multiple sclerosis
• space occupying lesion pressing on nerve
• bone deformity pressing
• connective tissue disease

Question 3

whats the presentation of a pt with trigeminal neuralgia?

Answer 3

UNILATERAL nerve pain
STABBING pain
5-10 seconds

triggers:
wind, cold, touch, chewing

Question 4

what are some red flags for patients who present with trigeminal neuralgia?

Answer 4

• younger patient (under 40)
• sensory deficit in facial region (like hearing loss)
• other cranial nerve lesions

(ALL PATIENTS NOW GET MRI)

Question 5

whats the first and second line drugs for trigeminal neuralgia?

Answer 5

First line (initial medicines)
- Carbamazepine
- oxcarbazepine
- lamotrigine

Second line (used if first line doesnt work)
- Gabapentin
- Pregabalin
- Phenytoin

Question 6

what are side effects of carbamazepine?

Answer 6

Blood Dyscrasia (condition)
- thrombocytopenia
- neutropenia
- pancytopenia

[(CY)TOPENIA = deficiency]

Electrolyte imbalances

neurological deficits (paraesthesia)

Liver toxicity

Skin reactions

Question 7

what are the indications of surgery for a patient with trigeminal neuralgia?

Answer 7

when approaching max tolerable medical management

younger pts with significant drug use - will have many years left of drug use

Question 8

what are the surgical options of trigeminal neuralgia?

Answer 8

• microvascular decompression
• stereotactic radiosurgery (radiation targeted at trigeminal ganglion to kill nerve cells)

Question 9

what are some complications after trigeminal neuralgia surgery?

Answer 9

sensory loss (corneal reflex, general sensation, hearing loss)
motor deficits

may REVERSIBLE or IRREVERSIBLE

Question 10

What is trigeminal autonomic cephalalgias?

Answer 10

group of primary headache disorders:

SEVERE
UNILATERAL HEAD PAIN
+
Autonomic symptoms: tearing, nasal congestion, eyelid drooping

Question 11

what branch of CNV is Trigeminal autonomic cephalalgias usually affecting?

Answer 11

Opthalmic Branch CNV1