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Similar to trigeminal neuralgia
trigeminal neuralgia
- 1. Trigeminal neuralgia Moderated by:Dr. Vidhi Rathi Presented by: Gauri Bargoti
- 2. NEURALGIA Pain of severethrobbing or stabbing character in the course of distribution of a nerve.
- 3. TRIGEMINAL NEURALGIA • Trigeminalneuralgia (TN) is sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve.
- 4. SYNONYMS • Trifacial neuralgia •Fothergill’s disease • Tic-doloureux (painful jerking)
- 5. ETOIOLOGY • INTRACRANIAL CAUSES 1.Petrous ridge compression-internal carotid artey pulsations 2. Multiple sclerosis 3. Intracranial tumors- at the cerebellopontine angle 4. Intracranial vascular abnormalities-basilar artery aneurysm, superior cerebellar artery abnormality
- 6. • EXTRACRANIAL CAUSES 1.Vascular factors 2. Dental etiology 3. Post traumatic neuralgia 4. Infections 5. Viral etiology
- 7. • Neuralgias andneuritis • Syphilis • Tuberculosis • Tumor of the brain • Basilar meningitis • Pontine diseases . • Skull fracture • Aneurysm of the carotid artery or circle of willis • Psychoneuroses,and • Cavernous sinus thrombosis Other disorders that may affect the trigeminal nerve include :
- 10. TYPES OF TRIGEMINAL NEURALGIA •Pre Trigeminal neuralgia • Idiopathic Trigeminal neuralgia • Symptomatic neuralgia
- 11. • Pre trigeminalneuralgia: dull aching pain usually observed before appearance of trigeminal neuralgia • Idopathic neuralgia: where the etiology remains unknown • Symptomatic neuralgia: the type in which the etiology is known
- 12. CLINICAL FEATURES • Incidence: 4 in 1,00,000 • Age : 4th to 5th decade • Sex : F>M • 60% on the right side, 3% bilateral. • Mean age of onset-52-58yrs
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- 14. • Manifests assudden, unilateral, intermittent, paroxysmal, sharp, shooting, lancinating pain, elicited by slight touch. • Patient usually complains of electric shock/lightening like pain • Usually confined to one part. • Lasts for few seconds to minutes. • Motionless or mask like face.
- 15. • Rarely crossesthe midline. • Trigger points - Spontaneous attack or triggered by trigger zone or movement of the face as in chewing, talking, brushing or yawning • This leads patient frequently go unshaven or unwashed • Paroxysms occur in cycles. • Depression and weight loss
- 16. Trigger zones areusually located on vermillion border of lip, ala of the nose, cheek, chin, and around the eye.
- 18. • There isgenerally no evidence of sensory or motor impairment • Apart from pain the other features are itching & sensitivity of the face • Rarely trigeminal neuralgia is associated with hemi facial spasm- a condition called TIC CONVULSIF that involves both V & VII cranial nerves
- 19. DIAGNOSIS • • • • • • History Trigeminal nerve examination Diagnosticnerve blocking MRI (brain) EEG Microneurography
- 20. DIFFERENTIAL DIAGNOSIS • • • • • • • • • Post herpeticneuralgia Dental pain Post traumatic neuralgia Multiple sclerosis Glossopharyngeal neuralgia Migraine SUNCT syndrome (sudden unilateral neuralgia type of pain with conjunctival involvement) Migraine Tumors of nasopharynx( trotter`s syndrome)
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- 22. PHARMACOLOGICAL • • • FIRST LINE OFAPPROACH Carbamazepine 100, 200mg.. SECOND LINE OF APPROACH Phenytoin 100mg Baclofen 5-80 mg/day Lamotrigine 25 mg/day THIRD LINE OF APPROACH Clonazepam 4-8 mg Valproic acid 250-500 mg Oxcarbazepine 1200mg/day
- 23. Other methods usedare • Trichloro ethylene inhalation • Topical capsaicin cream application • Proparacaine 0.5% anaesthetic drops in eye • Anti inflammatory drug-Indomethacin & short courses of steroids are found useful in some cases