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Group 6. Joaquin, Leviste, Libo -on, Ngo, Noche , Ocampo , Redota , Regalado , Rivera J., Tanbonliong , Teo , Tsai, Tud. Patient complains of left-sided shooting pains in the cheek and jaw area, precipitated by washing or shaving his face. Case. Primary Impression:.

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group 6

Group 6

Joaquin, Leviste, Libo-on, Ngo, Noche, Ocampo, Redota, Regalado, Rivera J., Tanbonliong, Teo, Tsai, Tud

slide2
Patient complains of left-sided shooting pains in the cheek and jaw area, precipitated by washing or shaving his faceCase
primary impression
Primary Impression:
  • Trigeminal Neuralgia
    • Also known as Tic Douloureux
  • Other names:
    • Prosopalgia
    • The Suicide Disease
    • Fothergill’sDisease
tic douloureux
Tic Douloureux
  • most common facial neuralgia
  • considered to be one of the more painful conditions to affect patients
    • sometimes described as the most excruciating pain known to humanity
  • most common site is the combination of second and third divisions
    • rarest = v3 combination
tic douloureux1
Tic Douloureux
  • Most common etiology
    • cross-compression of superior cerebellar artery
  • Incidence
    • Females are most commonly affected (around 60%)
    • Peak is during 5th to 7th decade of life
pain of tic douloureux
Pain of Tic Douloureux
  • Electric shock-like stabbing pain
  • Unilateral pain during any one episode
  • Abrupt onset and termination of pain
  • Pain-free intervals bet. Attacks
  • Non-noxious stimulation triggering pain which is often in a different area of the face
  • Minimal or no sensory loss in the region of pain
  • Pain restricted to trigeminal nerve
p palliative precipitating factors
P – Palliative, Precipitating Factors
  • Occur spontaneously or with movement of affected area
  • Trigger zones that provoke attacks (shaving, washing face, brushing teeth, smiling)
q quality
Q - Quality
  • Pain is so intense that it causes the patient to wince (hence the name ticdouloureux)
  • Episodes of severe, shooting or jabbing pain (single or in clusters) that may feel like an electric shock
r region radiation
R – Region, Radiation
  • Pain in areas supplied by the trigeminal nerve: cheek, jaw, teeth, gums, lips, or less often the eye and forehead
  • Unilateral pain during any one episode
s subjective description severity
S – Subjective description, Severity
  • Excruciating
  • Sometimes described as the most excruciating pain known to humanity
t timing
T - Timing
  • Pain seldom lasts more than a few seconds or a minute or two
  • Recur frequently, anytime of the day, several weeks at a time
  • Sudden onset, persist for weeks or months before remitting spontaneously
  • Recurrence common
physical examination
Physical Examination
  • Objective signs of sensory loss cannot be demonstrated at examination
diagnostic tests imaging modalities
Diagnostic Tests/Imaging Modalities
  • MRI - if atypical features are present
  • ESR - indicated if temporal arteritis is suspected
  • Neuroimaging studies
    • In typical cases of trigeminal neuralgia, usually unnecessary but may be valuable if multiple sclerosis is a consideration or in assessing overlying vascular lesions in order to plan for decompression surgery.