A Patient presents with recurrent episodes of sharp pain over his right cheek that is precipitated on chewing. Between attacks patient is otherwise normal. The most probable diagnosis is?
Answer is B (Trigeminal Neuralgia): Recurrent attacks of sharp pain over the cheek precipitated .from trigger areas or trigger factors such as chewing with the patient being normal in the interval period strongly suggests a diagnosis of Trigeminal Neuralgia. Trigeminal Neuralgia is typically characterized by Paroxysmal attacks of brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve lasting for a brief period from a fraction of a second to 2 minutes. The most common division of the trigeminal nerve involved in trigeminal neuralgia is the Maxillary division (V2) followed by the mandibular division (V3). The ophthalmic Division (VI) is rarely involved The pain often evokes spasm of the muscle of the face on the affected side. The clinical association between Trigeminal Neuralgia and hemifacial spasm is called Tic Douloureux. Typical Features of Trigeminal Neuralgia (Prosopalgia, Fothergill's disease) Sudden/ Abrupt onset and termination Sharp superficial, stabbing or burning in quality Severe in intensity Brief in duration (lasting for a brief period from a fraction of a second to 2 minutes) Intermittent (Between paroxysms the patient is usually asymptomatic. Following a painful paroxysm there is usually a refractory period during which pain cannot be triggered) Unilateral (The pain never crosses to the opposite side but it may rarely occur bilaterally in which case a central cause such as multiple sclerosis must be considered) Precipitated from trigger areas or by trigger factors in the trigeminal area such as eating or chewing, washing the face, shaving, smoking, talking or brushing the teeth There is no clinically evident neurological deficit Note : Trigeminal Neuralgia is More common with advancing age Trigeminal Neuralgia is More common in women Trigeminal Neuralgia is More common on right side Trigeminal Neuralgia attacks are most frequent during the day (but may awaken the patient at night) Trigeminal Neuralgia most frequently arises from the maxillary division of Trigeminal nerve (V2)
Preherpetic neuralgia
Trigeminal neuralgia
Mumps
Thalamic syndrome