Trigeminal neuralgia - Dr Sanjana Ravindra

Editor's Notes

• #4: The trigeminal nerve, CN V, is the fifth paired cranial nerve. It is also the largest cranial nerve.TN is the nerve responsible for most of the sensation in the face. It is bilaterally present. The motar component supplies masticatory muscles, mylohyoid, anterior belly of digastric tensor tympani, tensor veli palatine Sensory root comprises of y ganglion is present on the termporal bone or the meckels cave. From there, it divides into 3 branches First division is known as V1 provides sensation to the eye, upper eyelid and forehead V2 provides sensation to the cheek, lower eyelid, nostril, upper lip and gum V3 providessensation to the area of the jaw, lower lip and gum. Also controls muscles responsible for chewing
• #8: It is named so because pain paroxysm are usually accompanied by spasm of the ipsilateral facial muscles.
• #11: Dental pathosis – is belived by some investigators to be involved with the onset of trigeminal neuralgia Allergic- it can be secondary to an allergic and hypersensitivity reaction causing edema of the trigeminal nerve root Mechanical factors – like pressure due to aneurysms of the intrapetrous portion of the ICA tat may erode through the floor of the intracranial fossa to exert a pulsatile irritation on the ventral side of te trigeminal ganglion Anomalies of superior cerebellar artery – most recently blamed cause of trigeminal neuralgia. It lies in contact with te sensory root of the nerve and implicated as a cause of demyelnation Secondary lesion – conditions such as carcinoma of the maxillary antrum, nasopharyngeal carcinoma, tumors of peripheral; nerve root, intracranial vascular anomalies, and multiple sclerosis may be presented with TN
• #12: Classic TN- pain is generated because of compression of the trigeminal nerve most commonly at the root entry zone by an artery or vein. Compression of the trigeminal root can be caused by superior cerebellar artery or tortuous vein
• #13: It is likely that both central and peripheral changes occur, which would explain why not all patients with a treated compression of the nerve get permanent relief
• #14: THOSE WITH SYMPTOMATIC TRIGEMINAL neuralgia have either a compression of Tn caused by tumors or other structural abnormalities such as artieriovenous malformations, of multiple sclerosis Clasical TN includes all cases with no definitive etiology identified apart from vascular compression of trigeminal nerve
• #19: Quality of tn PAIN TYPICALLY ARISES IN THE PERSONS, WHO HAVE NO ABNORMAL NEUROLOGIC DEFICIT SUCH AS LOSS OF CORNEAL REFLEXES, ANESTHESIA, PARESTHESIA, MUSCULAR ATROPHY OR WEAKNESS ETC Even though there is a refractory period ie complete lack of pain between the attacks, some patients report a dull ache inbetween the attack The paroxysms occur in cycles, each cycle lasting for weeks or months and with time the cycle appears closer and closer.with each attack the pain seems to become more intense and unbearable.
• #20: The pain is provoked by light touch- trigger zones is an area of facial skin or oral mucosa where low intensity mechanical stimulation (light touch,an air puff, or even hair bending can elicit typical facial pain). Reported trigger factors are: specific area that, when stimulated by touch, pain, or pressure, excites an attack of neurologic pain.
• #23: Patient’s description of pain that are pathognomic for TN These descriptors imply not only the sharpness of the pain but also its rapidity and severity. Many patients vividly remember their first attack, and surgeons have gone so far as to say that patients who have a memorable onset are more likely to have good outcomes.13 The pain develops rapidly and lasts for no more than 2 min. Sometimes it is difficult for patients to appreciate that there are very short breaks between each attack of pain. Characteristically there is a refractory period. The severity of the pain varies from mild to extremely severe, resulting in weight loss and inability to maintain good oral hygiene
• #30: NEURALGIA : actual pain in a nerve, several nerves or groups of nerves NEUROPATHY : disturbance in function or damage to the nerves Neuropathic facial pain (NFP) is defined as pain around the mouth or face that arises from a primary lesion or dysfunction of the nervous system Neuralgia is a symptom of nerve dysfunction present within the brain stem or within the nerve segment running to the trigeminal ganglion located within the base of the middle cranial fossa
• #40: Insuuficient evidence to support use of peripheral treatments
• #42: Under heavy sedation/ short GA Ganglion is then lesioned under heat(RFT) INJ OF GLYCEROL Mechanical compression by use of a balloon
• #43: Ablative procedure Targets the trigeminal root entry zone in post cranial fossa Focuses a beam of radiation at this point Gamma Knife contains 192- 201 cobalt-60 sources of approximately 30 curies
• #44: MVD is a surgical procedure to relieve the symptoms (pain, muscle twitching) caused by compression of a nerve by an artery or vein. MVD involves surgically opening the skull (craniotomy) and exposing the nerve at the base of the brainstem to insert a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel.
• #45: As well as knowing the optimal drugs to use, it is important that doctors understand how patients can maximise the effects of these drugs. We provide information leaflets, which include some of the following instructions:
• #46:  President of the Confederate States of America [47] American politician who was a U.S. Representative and Senator from Mississippi, the 23rd U.S. Secretary of War, and the President of the Confederate States of America during the American Civil War. One of India's biggest film stars, Salman Khan, was diagnosed with TN in 2011. He underwent surgery in the US All-Ireland winning Gaelic footballer Christy Toye was diagnosed with the condition in 2013. He spent five months in his bedroom at home, returned for the 2014 season