Trigeminal neuralgia dkg
- 2. INRTODUCTION • TRIGEMINAL NEURALGIA (tic douloureux) is a relatively uncommon disorder of fifth cranial nerve. Trigeminal nerve is the largest cranial nerve. It is a mixed nerve. It has three divisions. 1. The ophthalmic division 2. The maxillary division 3. The mandibular division
- 7. DEFINITION • Trigeminal neuralgia can be defined as a neurologic condition of the trigeminal nerve characterized by paroxysms of sudden ,sharp ,stabbing pain which may be precipitated by stimulation of the trigger zones.
- 8. INCIDENCE The incidence is more in the elderly in about 50 to 70 years of age. It is commonly seen in males in a ratio of 2:1 .
- 9. ETIOLOGY • Idiopathic • Compression of blood vessels especially superior cerebral artery. • Herpes virus infection
- 10. PATHOPHYSIOLOGY • 1.DEGENERATIVE: it has been postulated that as people age the arteries elongate and become elastic and the brain sags more within the skull and this may bring the arteries such as the superior cerebellar artery into direct contact with the trigeminal nerve.
- 11. Cont.. •2.COMPRESSIVE:The compression to the trigeminal nerve can be caused due to tumors mainly the cerebellopontine angle for example meningiomas ,arteriovenous malformations
- 12. Clinical manifestations • Burning, lightning like pain in the lips, upper or lower gums, cheek , forehead or side of the nose. • Intense pain with frequent blinking and tearing of eye and a twitch of the mouth.(tic) • Total physical and psychological dysfunction.
- 13. Diagnostic studies • Computed tomography to rule out any lesion or vascular abnormalities. • MRI to rule out multiple sclerosis. • Lumbar puncture or CSF analysis • A complete neurologic assessment • Electromyography • Arteriography • Myelography.
- 14. Medical management • Antiseizure drugs • Local nerve block- administration with local anesthesia to trigeminal branches. • Biofeedback
- 15. SURGICAL MANAGEMENT • Glycerol rhizotomy through chemical ablation • Percutaneous radio frequency rhizotomy by destruction of sensory fibers by low voltage current. • Gamma knife radiosurgery • Suboccipital craniotomy
- 16. Nursing diagnosis • Acute pain related to inflammation or compression of the trigeminal nerve. • Imbalanced nutrition less than body requirements related to triggering pain by eating or chewing. • Anxiety related to uncertainty of timing and initiating event of pain and uncertainty regarding effectiveness of pain relieving treatments
- 17. Cont.. • Impaired oral mucous membrane related to unwillingness to practice oral hygiene measures secondary to potential for initiating pain.