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Trigeminal neuralgia

Sudden, lightning-like paroxysms of pain in the distribution of one or more divisions of the trigeminal nerve.

Aetiology is obscure and could be due to diabetes, Herpes zoster or alcohol.

Manifestations

When the onset of this disease occurs after 50 years it usually reflects a vascular compression by a tortuous  artery at the base of the brain.

If the onset occurs in younger individuals it often results from a Gasserian ganglion tumor or multiple sclerosis.

Manifestations

The history is diagnostic. The pain occurs as brief, lightning-like attacks, frequently precipitated by touching a trigger zone around the lips or the buccal cavity. At times, talking, eating, or brushing the teeth serves as a trigger. The pains rarely last longer than seconds, and each burst is followed by a refractory period of several seconds to a minute during which no pain can be precipi?tated. The pain is limited to the distribution of the trigeminal nerve, usually involving the second or third division or both.

The pain rarely occurs at night. Ordinarily, the neurologic examina?tion is entirely normal. Sensory changes in the distribution of the trigeminal nerve should prompt a careful/ search for structural disease such as tumor.

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Treatment

Carbamazepine is the initial treatment of choice; phenytoin and baclofen are occa?sionally effective.

If medical treatment fails, either radiofrequency lesions of the Gasserian ganglion (to block sensory conduction) or surgical relief of vascular pressure on the nerve is indicated.

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