Trigeminal neuralgia

trigeminal neuralgia

1. Trigeminal neuralgia Prepared by Wria S. rasheed

2. contents: Anatomy of trigeminal nerve Definition Clinical chara c teristics Causes Etiology Pathogenesis Types Diagnosis Differential Diagnosis Treatment

3. anatomy

4. Definition It is defined as sudden, usually unilateral, severe, brief, stabbing, lancinating, recurring pain in the distribution of one or more branches of the Vth cranial nerve

5. Clinical presentation In the early stages, the pain of trigeminal neuralgia may be rather mild and is often described by the patient as a twinge, dull ache, or burning sensation. This clinical presentation may be erroneously attributed to disorders of the teeth, jaws, and paranasal sinuses and lead to escalation of treatment and a variety of therapeutic misadventures . trigger zones Some patients are sensitive in certain areas of the face, which when touched cause an attack of pain .

6. Causes Main cause is damage to nerve leading to demyelination of nerve and finally leading to stabbing, severe, shock like pain resulting in neuralgia. Factors causing damage are- Old age Infection Multiple sclerosis Pressure on nerves Diabetes

7. Etiology Usually idiopathic Demylination of the nerve Multiple sclerosis Petrous ridge compression Post – traumatic neuralgia Intracranial tumors Intracranial vascular abnormalities Viral etiology

8. Compression of blood vessels, especially the superior cerebella r artery Chronic irritation of trigeminal nerve at the root entry zone Increased firing of the afferent or sensory fibres TRIGEMINAL NEURALGIA

9. P A THOGENESIS

10. types Typical trigeminal neuralgia: Most common form, previously termed IDIOPATHIC. Nearly all cases of typical trigeminal neuralgia are caused by blood vessel compressing the trigeminal nerve root.  Pulsation of vessels upon the trigeminal nerve root do not visibly damage the nerve. However irritation from repeated pulsations may lead to changes of nerve function, delivery of abnormal signals to the trigeminal nerve nucleus , this causes hyperactivity of trigeminal nerve root leading to trigeminal nerve pain

11. Atypical trigeminal neuralgia: it is characterized by a unilateral, prominent constant and severe aching and burning pain. Some believe that atypical trigeminal neuralgia is due to vascular compression upon specific part of the trigeminal nerve( the portio minor) while other theorize atypical trigeminal neuralgia as more severe progression of typical trigeminal

12. Pre- trigeminal neuralgia: Days to years before the first attach of trigeminal pain some sufferers experience odd sensations of pain,( such As toothache) or discomfort( parasthesia ). Multiple sclerosis related trigeminal Neuralgia: Symptoms of MS related trigeminal neuralgia are identical to typical trigeminal neuralgia. Bilateral trigeminal neuralgia is more commonly seen in people with MS. MS involves formation of demyelinating plaques within the brain.

13. Secondary or tumor related trigeminal neuralgia: Trigeminal pain caused by a lesion, such as a tumor. Tumor that severely compresses or distorts the trigeminal nerve may cause numbness, weakness of chewing muscles or constant aching pain

14. DIAGNOSIS The diagnosis of TD is based almost exclusively on the history and CT- scan , MRI also useful

15. Differential Diagnoses MIGRAINE SINUSITIS DENTAL PAIN- POST HERPETIC NEURALGIA Tumors of nasopharynx Cerebral Aneurysms

16. T R E A TM E NT Medical first line of treatment is : carbamazipine ( anticonvulsant) second line of treatment is : baclofen, oxcarbazepine , phenytoin, , pregabalin , low dose of antidepressants such as amitryptiline are thought to be effective in treating neuropathic pain. morphine and oxycodone , there is evidence of their effectiveness on neuropathic pain,

17. Surgical : Microvascular decompression; Percutaneous balloon compression; Percutaneous glycerol rhizotomy ; Percutaneous radiofrequency rhizotomy ;

18. reference Kellogg R, Pendleton C, Quinones-Hinojosa A, Cohen- Gadol AA (2010) Surgical treatment of trigeminal neuralgia: a history of early strides toward curing a ‘‘Cancerous Acrimony’’. Neurosurgery 67:1419–1425 Broggi G, Ferroli P, Franzini A, Galosi L (2005) The role of surgery in the treatment of typical and atypical facial pain. Neurol Sci 26:s95–s100 Nurmikko TJ, Eldridge PR (2001) Trigeminal neuralgia-pathophysiology, diagnosis and current treatment. Br J Anaesth 87: 117–132 Obermann M (2010) Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord 3:107–115 . Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM (2008) Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review ). Neurology 71:1183–1190

19. Mallin AW (1961) Trigeminal neuralgia in multiple sclerosis: report of two cases and review of literature. J Natl Med Assoc 53:18–23 Pawl RP (1997) Trigeminal neuralgia and atypical facial pain. Curr Pain Headache Rep 1:175–181 Freemont AJ, Millac P (1981) The place of peripheral neurectomy in the management of trigeminal neuralgia. Postgrad Med J 57:75–76