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    Trigeminal Neuralgia

    Trigeminal Neuralgia is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    Description

    • The trigeminal nerve (cranial nerve [CN] V) innervates the face, oral mucosa, nasal mucosa, and cornea with its sensory fibers
    • Trigeminal neuralgia is also known as tic douloureux:
      • Tic = spasmodic muscular contraction or movement
      • Douloureux = painful
    • Usually occurs in patients >50 yr of age
    • Facial pain syndrome recognizable by history alone
    • Classical:
      • Paroxysmal attacks of unilateral (uncommonly bilateral) pain affecting 1 or more divisions of the trigeminal nerve
      • Has 1 of the following characteristics:
        • Superficial, sharp, or stabbing pain
        • Precipitated from trigger areas or factors
      • Lasts for <1 sec–2 min
      • Episodes are stereotyped in each individual
      • No clinically evident neurologic deficit
      • Not caused by another disorder
    • Symptomatic:
      • Same as above but a causative lesion (not vascular compression) is identified
    • Most common age group is 50–60 yr
    • Females > males

    Etiology

    • Mechanism of pain production remains controversial; accepted theory suggests:
      • Demyelination of CN, leading to ectopic stimulation and pain:
        • Demyelination caused by tortuous or aberrant vascular compression of nerve root
        • 80–90% of classical trigeminal neuralgia have compression
        • Superior cerebellar artery is the most common (75%)
        • Anterior inferior cerebellar artery (10%)
    • Secondary causes:
      • Herpes zoster
      • Multiple sclerosis
      • Space-occupying lesions:
        • Cerebropontine angle tumor
        • Aneurysm
        • Arteriovenous malformation

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    Citation

    Rosen, Peter, et al., editors. "Trigeminal Neuralgia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia.
    Trigeminal Neuralgia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia. Accessed April 26, 2019.
    Trigeminal Neuralgia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia
    Trigeminal Neuralgia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Trigeminal Neuralgia ID - 307153 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -