Trigeminal neuralgia

trigeminal-neuralgia

Definition: It is aneuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It has been described as among the most painful conditions known.

Pathophysiology:

  • It is thought to be caused by an aberrant loop of the cerebellar arteries compressing the trigeminal nerve as it enters the brain stem.
  • Other compressive lesions, usually benign are occasionally found.
  • When trigeminal neuralgia occure in multiple sclerosis, there is a plaque of demyelination in the trigeminal root entry zone.

Clinical features:

  • Pain in the lips, gums, check or chin.
  • Pain seldom lasts more than a few seconds or a minute or two.
  • Intense that the patient winces hence the term tic.
  • Physical signs are usually absent.

Management:

[A] Medical therapy:

  • Carbamazepine is effective in 50-75% of patient. Carbamazepine shpuld be started as a single daily dose of 100 mg taken with food and increased gradually(by 100 mg daily every 1-2 days) up to 1200mg.Most patients require a maintence dose of 200 mg qid.
  • Gabapentin or pregabalin may be effective in patient who cannot tolerate carbamazepine.

[B] Surgical therapy:

  • Injection of alcohol or phenol into peripheral branch of the nerve.
  • The most widely applied procedure creates a heat lesion of the trigeminal (gasserian) ganglion or nerve a method termed radiofrequency thermal Rhizotomy.
  • The vascular compression of the trigeminal nerve can be relieved through a posterior craniotomy.

Trigeminal nerve disorder:

[A] Nuclear lesions:

  • Muliple sclerosis.
  • Stroke.
  • Syringobulbia.
  • Lymphoma.
  • Glioma.

[B] Preganglionic lesions:

  • Acoustic neuroma.
  • Meningoma.
  • Chronic meningits.

[C] Gasserian ganglion lesion:

  • Trigeminal neuroma.
  • Herpeszoster.
  • Infection.

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