1.Trigeminal Neuralgia tic douloureux
Introduction
Trigeminal neuralgia is characterized by unilateral, repetitive, unilateral, and excruciating pains confined to the distribution of, typically, the second, but sometimes third, branch of the trigeminal nerve, cranial nerve V.
-Typically presents in middle or old age.
-It affects women more frequently than men
Symptoms & Signs
-TN is typically unilateral.
-The paroxysms tend to recur frequently
-The pain exacerbated by touch
-Frequent, excruciating paroxysms of pain in lips, gums, cheek, or chin lasting seconds to minutes.
-In a patient younger than 40 years presenting with trigeminal neuralgia, multiple sclerosis must be suspected
-Objective signs of seonory loss cannot be demonstrated on examination
Diagnosis
-The history is key for diagnosis
-Brain MRI if secondary cause is suspected
Treatment
Medications: Carbamazepine, Oxcarbazepine, Phenytoin, Baclofen, Topiramate, Lamotrigine, Gabapentin
Carbamazepine: Carries the risk of agranulocytosis
Surgery: Microvascular surgical decompression, radiofrequency thermal rhizotomy, gamma knife radiosurgery, peripheral neurectomy
Prognosis
-Spontaneous remissions may occur for several months or longer
Q.What do you suspect in a young patient with bilateral trigeminal neuralgia? Multiple sclerosis