TRIGEMINAL NEURALGIA

Severe repeated lancinating pain (‘like electric shock’) in one half of face over distribution of a facial branch of trigeminal nerve, mostly of 2nd or 3rd divisions.

• Precipitating factors like mastication, skin touch, draft or teeth brushing.
• Pain ‘bursts’ several times with a refractory period thereafter.
• Most commonly due to compression of the trigeminal nerve by arteries or veins in the posterior fossa.
• Increasing frequency overtime, and later a dull persistent pain over the area.
• No objective neurologic signs. Presence of sensory loss rules out the diagnosis of trigeminal neuralgia.

In young patients suspect multiple sclerosis as the cause, and in any patient if there are neurologic signs, rule out cerebello-pontine angle tumour by MRI or CT scan with thin posterior fossa cuts