The section, EDAIC Multiple Choice Question and answer, covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.
Question: Trigeminal neuralgia:
- Affects females more than males.
- Multiple sclerosis is a risk factor.
- Pain is characteristically continuous.
- It may be associated with neurological defects
- Anhedonia and depression are common accompaniments.
Answers:
- true
- true
- false
- false
- true
Explanation:
Trigeminal neuralgia is seen more in females.
Risk factors:
- Multiple sclerosis, (where it is seen bilaterally as opposed to a more common unilateral form).
- Increased age.
- Hypertension.
Pathophysiology and clinical presentation
The trigeminal nerve is compressed in the root entry zone, which is an area of transition from central to peripheral myelin which is sensitive to pressure. The pain is in paroxysms and is because of demyelination and extra-synaptic transmission of impulses.
Only 4% manifest as bilateral pain, while 60% have right-sided predominance.
Most commonly involved are the mandibular and maxillary.
Demyelination is associated with changes in water diffusion that can be detected by diffusion tracer imaging.
Precipitating factors:
- Chewing and talking (76%)
- Touching (65%)
- Cold (48%).
- Allodynia and sensory (especially in atypical trigeminal neuralgia)
# Trigger points are less than 10 mm in the oral mucosa or perineal area. Atypical TN is usually resistant to single-agent and surgery. Extraction of the third molar is especially associated with TN.
Management
Carbamazepine (beneficial in 70% of patients). It may cause fluid retention and hyponatremia along with osteoporosis, neutropenia and megaloblastic anaemia.
Oxcarbazepine is excreted renally, so it has fewer side effects.
Gasserian ganglion bock is approached through the foramen ovale and may cause numbness, increased recurrence, cardiac arrhythmias, cardiac arrest and anaesthesia Dolorosa (severe constant pain associated with numbness).
Radiofrequency has a recurrence rate of 40% at 5 years.
Balloon compression causes ischaemic damage to rootlets and ganglion cells. Side effects include transient masseter weakness, vascular
injury and aseptic meningitis.
The recurrence is seen within 3 years of glycerol rhizotomy.
Posterior fossa microsurgery is the most effective treatment with 73% having complete pain relief at 5 years. It is associated with corneal numbness, meningitis, cerebral infarcts, GI bleeding, pulmonary emboli and diplopia.
Diplopia seen is transient.
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‘EDAIC Multiple Choice Question and answer’ covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.
