Trigeminal neuralgia (tic douloureux) is a disorder of the sensory nucleus of the 5th cranial nerve (trigeminal nerve) which causes bouts of severe lancinating pain along the nerve. Trigeminal neuralgia is often precipitated by stimulation of well-defined trigger paths, usually around the mouth and nose,and, occasionally inside the mouth. Trigeminal neuralgia usually affects only one side (ipsilateral).
Trigeminal neuralgia is most commonly compression of the trigeminal nerve by arteries or veins of the posterior fossa. Inflammatory and degenerative changes are often found in the semilunar ganglion.
Causes of neuralgia include: Chronic intoxication (alcohol, arsenic, lead, other drugs); Viral infections (post-herpetic); Bacterial infections (Shigella, Brucella, Leptospirosis, Lyme, Secondary syphilis, Mycobacterium leprae); Metabolic and inflammatory disorders (diabetes, gout, rheumatoid arthritis, systemic lupus erythematosus); Vitamin deficiencies (B1, B12, B3, B6, E); Drug reaction (chloramphenicol, nitrofurantoin, sulfonamides, isoniazid) and serum sickness (an allergic reaction to drugs); Multiple sclerosis (optic neuritis).
An MRI or CT scan is usually ordered to rule out neoplasm in cerebellopontine angle. An ESR is ordered to rule out arteritis. A VDRL for syphilis is sometimes ordered (secondary syphilis causes cranial nerve lesions).
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