Andy and Rick.  PC 56 y.o. male w. severe stabbing pains in the R. side of face.  HPC Appeared ~6mths ago. ↑ in frequency. Lasts only a few secs. Occurs.

Slides:



Advertisements
Similar presentations
Vessels and nerves of the face: Part of the head and neck file.
Advertisements

FACIAL PAIN AND HEADACHE
Headache: When to see a physician Morris Levin, MD Section of Neurology Dartmouth Medical School.
DENTAL GROSS ANATOMY CASE 2.2.
02/05/20151 HEADACHES; When to seek advice? DR FAYYAZ AHMED CONSULTANT NEUROLOGIST HULL & EAST YORKSHIRE HOSPITALS NHS TRUST.
HEADACHE & FACIAL PAIN Ahmed Alarfaj,MD. INTRODUCTION Major reason for seeking medical care. Major reason for seeking medical care. 90% is vascular headache.
By Dr. Ravindra Srivastava Consultant Neurosurgeon VIMHANS, New DELHI
Evaluation and management of Bell’s palsy Chunfu Dai Otolaryngology Department Fudan University.
2008. Diagnostic criteria  At least 10 episodes fulfilling following criteria  Headache lasting 30 mins to 7 days  Has 2 at least 2 of the following.
PRIMARY TRIGEMINAL NEURALGIA Zheng Dongming Neurology Ward.
A 56-year-old man with intense facial pain Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.
Facial Pain: Diagnosis and treatment
Headache diagnosis and treatment : now and the future Paul Rolan MBBS MD FRACP FFPM DCPSA Professor of Clinical Pharmacology Senior Consultant, Pain Management.
Department of Neurology, SJUH Acute headache Problems that can not wait until the post take ward round
Headache & Facial Pain John F. Rothrock, M.D. Professor & Vice Chair, UAB Neurology.
跳转到第一页 Headache Zheng Dongming. 跳转到第一页 n The most common symptom in clinic n the causes are myriad. 1.intracranial disease 2.extracranial disease 3.functional.
Irritable Bowel Syndrome Biol E-163 TA session 12/18/06.
Dr. amal Alkhotani Frcpc neurology, epilepsy
Headaches By: Gabie Gomez. Why does my head hurt ????? Headaches are a neurological complaint that can be insignificant or prodromal. The exact mechanism.
Concepts Related to the Care of Individuals PAIN Concepts of Nursing NUR 123.
Headache Dr. Mansour Al Moallem.
Rational brain imaging in primary care
Trigeminal neuralgia (tic douloureux) painful twitch
School of Clinical Medicine School of Clinical Medicine UNIVERSITY OF CAMBRIDGE Headache Jane Smith, a 23 year old woman, presents to her GP complaining.
Guillain-Barré Syndrome Miss Fatima Hirzallah Guillain-Barré syndrome is an autoimmune attack on the peripheral nerve myelin. The result is acute, rapid.
Trigeminal (Gasserian) Ganglion Block
Endometrial Carcinoma
TRIGEMINAL NEURALGIA. Dr.Haris PS/OMR Introduction  Disorder characterized by lancinating attacks of severe facial pain  Diagnosis based primarily on.
Learn More At: Dose-Response and Dose- Complications Relationships in Stereotactic Radiosurgery for Trigeminal Neuralgia Sandra.
Trigeminal Neuralgia How Can A Neurologist Help? Summary of a presentation to Dallas TN Association November 7 th, 2007 Norma Melamed, MD Hillcrest.
In the name of Allah, the Beneficent, the Merciful.
NOTE: To change the image on this slide, select the picture and delete it. Then click the Pictures icon in the placeholder to insert your own image. Amr.
INCORRECT In vestibular neuritis, the vertiginous attack lasts hours to several days and is not clustered in spells as in this patient. Please try again.
What’s up with Acoustic Neuromas? Nancy Fuller, M.D. PCC September 27, 2006.
MULTIPLE SCLEROSIS Ana Costas Barreiro.
Vertigo Dr. Abdulrahman Alsanosi Assistant professor King Saud University Otolaryngology consultant Otologist, Neurotologist &Skull Base Surgeon King Abdulaziz.
Cervical Radiculopathy. Normal Anatomy Cervical spinal nerves exit via the intervertebral foramen Intervertebral foramen is the gap between the facet.
Facial pain.
Trigeminal Nerve.
CT Scan and MRI spinal imaging findings in Spontaneous Intracranial Hypotension: a case report Sérgio Cardoso Radiology Department - Hospitais Cuf Lisbon,
Approach to the Patient with Head and Facial Pain Neurology
Vertigo Dr. Abdulrahman Alsanosi Associate professor Otolaryngology consultant Otologist, Neurotologist Head of Otology / Neurotology Unit Director of.
A few headache cases. GA 1 Please see this 65 y.o. retired shoe designer with occipital headaches for 3 months not helped by physiotherapy. Woken at night.
Katrin Vestrik Form 9a.   Brain  Nerves  Head pain system  Channels  Sleep affects headaches Keypoints :
HR Saeidi MD Associate Professor of NeurosurgeryKUMS.
Dr. Rupak Sethuraman. SPECIFIC LEARNING OBJECTIVES Various management techniques of orofacial pain Management of common orofacial pain disorders.
원더스 참고자료 두통. 1 차성 두통에 대한 자료 2 차성 두통에 대한 자료.
Trigeminal Nerve D.Nimer D.Rania Gabr D.Safaa D.Elsherbiny.
Cranial nerves pathology Dr. Massud Wasel MD DO ND BSc (Hons) P.G.C.A.P Fellow of Higher Education Academy.
Oral Medicine & Radiology
Facts About Headache. A headache is defined as "a pain or ache in the head...It accompanies many diseases and conditions, including emotional distress."
ATI NEUROSTIMULATOR SYSTEM for cluster headaches Autonomic Technologies Inc.
Lumbar Stenosis.
Oral Surgery Diagnosis
Cervical spine Symptoms:
Headaches Jo Swallow ST1s May 2009.
ATI NEUROSTIMULATOR SYSTEM for cluster headaches
بسم الله الرحمن الرحيم.
Dr. Saad Al Asiri FACIAL PAIN & HEADACHE MD, DLO, KSF, Rhino
Headache.
Are you getting the best treatment for your low back pain?
HEADACHE.
Headaches Feedback from BASH 3rd Nov 2017.
Neuro-ophthalmology.
Headache.
Headache is a common presenting complaint and certainly something you’ll encounter many times over your career. The vast majority of headaches are not.
MRI Brain Evaluation of brain diseases Stroke
Pre-op NS-2. HISTORY 63yr male k/c/o DM,HTN and CAD on medications for past 20yrs presented to hospital with chief c/o right sided nape of.
Dr sadik al ghazawi Associated professer Neurologist Mrcp,frcp uk
Dr sadik al ghazawi Associated professer Neurologist Mrcp,frcp uk
Presentation transcript:

Andy and Rick

 PC 56 y.o. male w. severe stabbing pains in the R. side of face.  HPC Appeared ~6mths ago. ↑ in frequency. Lasts only a few secs. Occurs several times a day Triggers – shaving, drinking, eating, windy days Recent wt. loss Dentist found no tooth-related issues  Ex Neuro exam finds no abnormalities EXCEPT when the face was tested for touch and pain (?) sensibility, triggered an attack each time R. cheek was touched

 DDX (wrong) Dental pian (poor dentist?) Temporal arteritis Cluster headache Maxillary sinusitis TMJ dysfunction  Up-to-date DDx Short-lasting unilateral neuralgiform headache w. conjunctival injection and tearing (SUNCT) Cluster tic syndrome Jabs and jolts syndrome ‘Other’ neuralgias (Postherpatic,  Provisional Dx Trigeminal Neuralgia  Many potential causes of this

 In short; there is insufficient evidence to support or refute the utility of MRI to identify neurovascular compression in classic TN, or to indicate the most reliable MRI technique  But…. Neuroimaging with head CT or MRI is useful for identifying the small proportion of patients who have a structural lesion (eg, tumor in the cerebellopontine angle, demyelinating lesions including multiple sclerosis) as the cause of secondary TN. In addition, high resolution MRI and magnetic resonance angiography (MRA) may be useful for identifying vascular compression as the etiology of classic TN, but the utility of these studies has not been established.  It is suggested to obtain brain MRI for patients in the following groups to rule out a causative structural brain lesion: Patients with trigeminal sensory loss Patients with bilateral symptoms Young patients (under the age of 40)

 carbamazepine controlled-release 100 mg orally, once or twice daily; increase as tolerated and according to response every 7 days up to a maximum of 600 mg twice daily. After pain relief has been maintained for several weeks, the dose should be gradually reduced to establish the minimum dose that will provide good pain control.  If carbamazepine is ineffective, options include referral to a neurosurgeon or trial of other drugs alone or in combination with carbamazepine.  Murtagh suggests these as options for alternative drug therapy: Gabapentin Phenytoin Clonazepam Baclofen  Surgery Possible procedures include:  Decompression of the trigeminal nerve root (eg. Gel foam packing between the nerve and blood vessels  Thermocoagulation/radiofrequency neurolysis  Surgical division of the peripheral branches

 THE REST OF THIS DOC IS A GOOD CONCISE SUMMARY OF TRIGEMINAL NEURALGIA FROM MURTAGHS

 Trigeminal neuralgia (tic douloureux) is a condition of often unknown cause that typically occurs in patients over the age of 50, affecting the second and third divisions of the trigeminal nerve and on the same side of the face. Brief paroxysms of pain, often with associated trigger points, are a feature.

 Site: sensory branches of the trigeminal nerve almost always unilateral (often right side)  Radiation: tends to commence in the mandibular division and spreads to the maxillary division and (rarely) to the ophthalmic division  Quality: excruciating, searing jabs of pain like a burning knife or electric shock  Frequency: variable and no regular pattern  Duration: minutes (up to 15 minutes)  Onset: spontaneous or trigger point stimulus  Offset: spontaneous  Precipitating factors: talking, chewing, touching trigger areas on face (e.g. washing, shaving, eating), cold weather or wind, turning onto pillow  Aggravating factors: trigger points usually in the upper and lower lip, nasolabial fold or upper eyelid  Relieving factors: nil  Associated features: rarely occurs at night spontaneous remissions for months or years  Signs: there are no signs, normal corneal reflex  Causes: unknown local pressure on the nerve root entry zone by tortuous pulsatile dilated small vessels (probably up to 75%) multiple sclerosis neurosyphilis tumours of the posterior fossa  Note: Precise diagnosis is essential.

Trigeminal neuralgia: typical trigger points

 Patient education, reassurance and empathic support is very important in these patients.  Medical therapy: carbamazepine (from onset of the attack to resolution)4 50 mg (elderly patient) or 100 mg (o) bd initially, gradually increase the dose to avoid drowsiness every 4 days to 200 mg bd (maintenance); testing serum levels is unnecessary; higher dosage may be necessary alternative drugs if carbamazepine not tolerated or ineffective (but question the diagnosis if lack of response)  gabapentin 300 mg daily initially, then increase  phenytoin mg daily  clonazepam  baclofen  Surgery: refer to a neurosurgeon if medication ineffective possible procedures include:  decompression of the trigeminal nerve root (e.g. gel foam packing between the nerve and blood vessels)  thermocoagulation/radiofrequency neurolysis  surgical division of peripheral branches