Trigeminal Neuralgia
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Basics
Description
- The trigeminal nerve innervates the face, oral mucosa, nasal mucosa, and cornea with its sensory fibers
- Trigeminal nerve = Cranial nerve (CN) V
- Synonym: Tic douloureux:
- Tic = spasmodic muscular contraction
- Douloureux = painful
- Usually occurs in patients >50 yr of age
- Most common age group is 50–60 yr
- Females > males
- Facial pain syndrome recognizable by history alone
- Classical:
- Paroxysmal attacks of unilateral (rarely bilateral) pain affecting 1 or more divisions of the trigeminal nerve
- Has 1 of the following characteristics:
- Superficial
- Sharp
- Stabbing pain
- Precipitated from trigger areas or factors
- Lasts for <1 s–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
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%)
- Demyelination of CN, leading to ectopic stimulation and pain:
- Secondary causes:
- Herpes zoster
- Multiple sclerosis
- Space-occupying lesions:
- Cerebellopontine angle tumor
- Aneurysm
- Arteriovenous malformation
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- The trigeminal nerve innervates the face, oral mucosa, nasal mucosa, and cornea with its sensory fibers
- Trigeminal nerve = Cranial nerve (CN) V
- Synonym: Tic douloureux:
- Tic = spasmodic muscular contraction
- Douloureux = painful
- Usually occurs in patients >50 yr of age
- Most common age group is 50–60 yr
- Females > males
- Facial pain syndrome recognizable by history alone
- Classical:
- Paroxysmal attacks of unilateral (rarely bilateral) pain affecting 1 or more divisions of the trigeminal nerve
- Has 1 of the following characteristics:
- Superficial
- Sharp
- Stabbing pain
- Precipitated from trigger areas or factors
- Lasts for <1 s–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
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%)
- Demyelination of CN, leading to ectopic stimulation and pain:
- Secondary causes:
- Herpes zoster
- Multiple sclerosis
- Space-occupying lesions:
- Cerebellopontine angle tumor
- Aneurysm
- Arteriovenous malformation
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