What is trigeminal neuralgia?
A chronic pain disorder that affects the trigeminal nerve. There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes
What is thought to be the cause of trigeminal neuralgia?
Compression of the trigeminal nerve at or near the pons by an ectatic vascular loop is the usual cause
What is the main risk factor for development of trigeminal neuralgia?
What are features of trigeminal neuralgia?
Paroxysms of intense pain, lasting seonds, in trigeminal distribution:
What are triggers of trigeminal neuralgia?
- Washing face
What sex does trigeminal nerualgia occur more commonly in?
What are secondary causes of trigeminal neuralgia?
- Anomylous intracranial vessels
- Chronic meningeal inflammation
- V. Zoster
- Skull base malformation
What investigations would you perform if you suspected trigeminal neuralgia?
MRI - look for secondary cause
What medical treatments could you use to manage trigeminal neuralgia?
- First line - Carbemazapine
- Second line - Gabapentin/Pregabalin/Amitriptyline
What surgical options are available for refractory trigeminal neuralgia?
- Microvascular decompression
- Ablative rugical procedures
What are the risks with ablative surgical procedures for treating trigeminal neuralgia?
Destroy facial sensation in distribution of nerve ablated - however does stop pain