15A. Trigeminal neuralgia

Definition

Trigeminal neuralgia is a type of facial neuropathic pain restricted to one or more divisions of the trigeminal nerve. The pain is recurrent, abrupt in onset and termination, triggered by innocuous stimuli and typically compared to an electric shock or described as shooting or stabbing.

It usually affects elderly.

Etiology

  • Classic type – due to neurovascular compression of the trigeminal nerve root by a vessel
  • Secondary
    • Multiple sclerosis
    • Tumour
  • Idiopathic

Clinical features

The patient has attacks of very severe facial pain in the area of one or more branches of CN V. The pain is sharp and stabbing and lasts for seconds. They may experience many episodes each day (up to 100).

The pain can occur at rest or in association with movements like chewing, talking, touching, etc.

Diagnosis and evaluation

CT or MR angiography can give information on the cause of the trigeminal neuralgia.

Treatment

The treatment is as for other neuropathic pains, most importantly antiepileptics like carbamazepine, pregabalin, and gabapentin. Surgery may treat the neurovascular compression.


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15B. Neuromyelitis optica (Devic-disease)

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