Cranial Nerve Neuralgias
Trigeminal Neuralgia
Clinical Presentation
- Excruciating paroxysms of pain in the ophthalmic division of the fifth nerve.
- lasts more than a few seconds or a minute.
- Sharp jabbing pain
- recurring – both day and night, for several weeks at a time
- Presence of trigger zones, typically on the face
- patients may report that tactile stimuli—e.g. washing the face, brushing the teeth, or exposure to a draft of air—generate excruciating pain.
- No sensory loss
Differential Diagnosis
- TMJ pain
- Teeth pain
- Sinusitis
- Migraine
- Cluster headache
- Temoral arteritis
- Trigeminal nerve neuropathy (sensory or motor problems)
- Connective tissue disease
- Tumours
- Cavernous sinus syndrome
| Side note cluster headache is associated with trigeminal neuralgia, a syndrome known as cluster- tic. |
Investigations
- ESR
Bell's Palsy
Facial nerve is cranial nerve number VII and supplies muscles of facial expression
Anatomy
- Motor
- anterior wall of the external auditory canal
- Sensory
- Anterior 2/3 of tongue – taste
Glossopharyngeal Neuralgia
Cavernous Sinus Syndrome
Aetiology
- Cavernous sinus thrombosis – secondary to infection
- Orbital cellulitis (frequently Staphylococcus aureus)
- Sinusitis (especially with mucormycosis in diabetic patients)
- Carotid artery aneurysm
- Carotid-cavernous fistula (orbital bruit may be present)
- Meningioma
- Nasopharyngeal carcinoma
- Idiopathic granulomatous disorder (Tolosa-Hunt syndrome).