Armando Hasudungan
Biology and Medicine videos

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.


  • ESR



Bell's Palsy

Facial nerve is cranial nerve number VII and supplies muscles of facial expression


  • Motor
    • anterior wall of the external auditory canal
  • Sensory
    • Anterior 2/3 of tongue – taste


Glossopharyngeal Neuralgia

Cavernous Sinus Syndrome


  • 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).