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Group 6

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

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  1. Group 6 Joaquin, Leviste, Libo-on, Ngo, Noche, Ocampo, Redota, Regalado, Rivera J., Tanbonliong, Teo, Tsai, Tud

  2. Patient complains of left-sided shooting pains in the cheek and jaw area, precipitated by washing or shaving his face Case

  3. Primary Impression: • Trigeminal Neuralgia • Also known as Tic Douloureux • Other names: • Prosopalgia • The Suicide Disease • Fothergill’sDisease

  4. 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

  5. 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

  6. Pathophysiology

  7. 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

  8. History and PHYSICAL Examination

  9. P – Palliative, Precipitating Factors • Occur spontaneously or with movement of affected area • Trigger zones that provoke attacks (shaving, washing face, brushing teeth, smiling)

  10. 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

  11. 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

  12. S – Subjective description, Severity • Excruciating • Sometimes described as the most excruciating pain known to humanity

  13. 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

  14. Physical Examination • Objective signs of sensory loss cannot be demonstrated at examination

  15. Differential diagnoses

  16. Possible Differentials

  17. Possible Differentials

  18. Diagnostics/imaging

  19. 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.

  20. Treatment (Pharmacologic & non-pharmacologic)

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