A 50-year-old man presents to his physician with complaints of electric shock like
pain on right side of the face. It is usually triggered in the morning by shaving. Pain
does not occur at night.
a) What is your diagnosis?
b) What treatment options are available?
This is characterised by lancinating (electric shock like) pain in the second and third divisions of the trigeminal nerve territory, usually in patients over the age of 50 years.
Pathophysiology
Trigeminal neuralgia is thought to be caused by an aberrant loop of the cerebellar arteries compressing the
trigeminal nerve as it enters the brain stem. When trigeminal neuralgia occurs in multiple sclerosis, there is a plaque of demyelination in the trigeminal root entry zone.
Clinical features
The pain is severe and very brief but repetitive, causing the patient to flinch as if with a motor tic (hence French term for the condition, ‘tic douloureux’). Physical signs are usually absent. Similar symptoms may occur in multiple sclerosis or, rarely, with other brain-stem lesions. There is a tendency for the condition to remit and relapse over many years. It may be precipitated:
- by touching trigger zones within the trigeminal territory
- by cold wind blowing on the face
- by eating.
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Management
The pain usually responds at least partially to carbamazepine. It is wise to start with a low dose and increase gradually, according to effect.If patients cannot tolerate carbamazepine, gabapentin, pregabalin, amitriptyline or steroids may help.
Surgical treatment should be considered, especially where response is incomplete in younger patients. Decompression of the vascular loop encroaching on the trigeminal root (through a posterior craniotomy) is said to have a 90% success rate. Otherwise, localized injection of alcohol or phenol into a peripheral branch of the nerve may be effective. Probably more effective is making a radiofrequency lesion in the nerve near the Gasserian ganglion.
A 50-year-old man presents to his physician with complaints of electric shock like
pain on right side of the face. It is usually triggered in the morning by shaving. Pain
does not occur at night.
a) What is your diagnosis?
b) What treatment options are available?
I will write natural health and medicine blog articles – Level 2 seller on FIVERR