Q 2.3. Trigeminal neuralgia

Q 2.3. Trigeminal neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which is responsible for sensation in the face. The pain is usually felt on one side of the face and is described as intense, stabbing, electric-like, or burning. The pain can be triggered by various stimuli, such as touching the face, chewing, talking, or brushing the teeth. The pain can last from a few seconds to several minutes and can occur sporadically or frequently.
 
ETIOLOGY

The most common cause of trigeminal neuralgia is compression of the trigeminal nerve by a blood vessel at the base of the brain. This can damage the protective layer of the nerve, called the myelin sheath, and make the nerve more sensitive. Other causes of trigeminal neuralgia include multiple sclerosis, tumors, infections, trauma, or dental procedures.

 
DIAGNOSIS

The diagnosis of trigeminal neuralgia is based on the history, physical examination, and sometimes additional tests, such as nerve conduction studies, electromyography, imaging studies, or blood tests. 
 

MRI is the first-line imaging modality for trigeminal neuralgia, as it can show the anatomy of the brain, the trigeminal nerve, and the surrounding structures. MRI can also detect lesions that may cause trigeminal neuralgia, such as demyelination, inflammation, or mass effect.

The FIESTA MRI sequence is a type of 3D gradient echo imaging that produces high-resolution images of fluid-filled structures, such as the cerebrospinal fluid, the inner ear, the cranial nerves, and the blood vessels. The FIESTA sequence can be useful for diagnosing the cause of trigeminal neuralgia, as it can assess the trigeminal nerves from their origin at the mid pons anteriorly, through the prepontine cistern until the Meckel’s cave (trigeminal ganglion). The FIESTA sequence can also depict the vascular anatomy near the trigeminal nerve, and detect any vascular compression, aneurysms, arteriovenous malformations, or vascular malformations.

The FIESTA sequence can be performed with or without contrast, depending on the clinical suspicion. 

TREATMENT AND PROGNOSIS

The treatment of trigeminal neuralgia depends on the cause, severity, and response of the condition. The main treatment options are medications, such as anticonvulsants, antispasmodics, or neurotoxins, and surgical procedures, such as microvascular decompression, balloon compression, radiofrequency thermal lesioning, or stereotactic radiosurgery.

The prognosis of trigeminal neuralgia varies depending on the cause and outcome of the treatment. Some patients may experience complete or partial relief of pain, while others may have persistent or recurrent pain. The quality of life and psychological well-being of the patient may also be affected by trigeminal neuralgia, as it can impair communication, social interaction, and self-esteem.

In conclusion, trigeminal neuralgia is a disorder that causes severe pain in the face due to damage or irritation of the trigeminal nerve. It can have various causes, symptoms, treatments, and outcomes, depending on the individual case. The most important things to remember are:

– Trigeminal neuralgia causes intense, stabbing, or electric-like pain in the face, usually on one side.
– The most common cause of trigeminal neuralgia is compression of the trigeminal nerve by a blood vessel at the base of the brain which may be confirmed by MRI studies.
– The treatment of trigeminal neuralgia depends on the cause and severity, but medications and surgical procedures are often used.
– The prognosis of trigeminal neuralgia varies, but some patients may recover fully, while others may have permanent or recurrent pain.