questions 2

Trigeminal Neuralgia

Topic updated on 11/13/17 2:26pm

Snapshot
  • A 54-year-old female presents with severe, stabbing pain on her left mandible. The pain lasts a few seconds and is triggered by brushing her teeth or chewing food. The pain episodes lasts a few seconds and occur 20 times per day. She denies any recent trauma or dental procedures. Over the counter simple analgesics do not improve the pain. On physical exam, touching the mandibular region reproduces the pain. Neurological exam is otherwise normal.
Introduction
  • Severe, sharp, stabbing pain in one or more trigeminal nerve (CN V) divisions
    • onset and termination is abrupt
    • commonly involving V2 and V3 branches of CN V
  • Pathophysiology
    • most commonly due to neurovascular compression
      • involving the superior cerebellar artery
    • compression can also be due to malignancy, amyloidosis, or plaque (e.g., multiple sclerosis)
  • Epidemiology
    • more commong in women
    • age: > 50-years-old
    • may be a manifestation of multiple sclerosis
Presentation
  • Symptoms
    • sharp, shock-like pain in one more more CN V divisions
      • typically unilateral
      • usually lasts seconds long
      • can be triggered by mechanical stimuli
        • e.g., brushing teeth, smiling, chewing
Evaluation
  • Clinical diagnosis
Differential
  • Dental pain
  • Cluster headache
  • Temporomandibular joint (TMJ) pain
  • Glossopharyngeal neuralgia 
Treatment
  • Medical
    • carbamazepine 
      • first-line
    • oxcarbazepine
  • Surgical - for refractory cases
    • microvascular decompression
    • rhizotomy
    • radiosurgery
Prognosis, Prevention, and Complications
  • Complications
    • issues with eating and drinking


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