Trigeminal Neuralgia
ICD-10
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Paul Rizzoli
ICD-10 G50 Disorders of the trigeminal nerve
G50.1 Atypical facial pain G50.8 Other disorders of the trigeminal nerve G50.9 Disorder of the trigeminal nerve, unspecified
information travels through a large sensory root to enter the mid-lateral pons. Compression at the level of the root entry zone by a vessel (usually the superior cerebellar artery) is a common cause; the resulting clinical picture is termed classical trigeminal neuralgia. Compression is thought to produce focal demyelination, which leads to ectopic impulse generation and ephaptic transmission responsible for generating symptoms.
Definition
Clinical Features
A distinctive recurrent painful facial pain disorder characterized by brief, severe shock-like pains limited to one or more divisions of the trigeminal nerve.
The classical form is a painful relapsing and remitting condition that most often strikes those over age 50 with a peak incidence in the fifth to seventh decades. Estimates of prevalence are between 4 and 13 cases per 100,000 per year, with a slight female predominance. Though most often sporadic, rare familial cases are described. The pain has an abrupt onset and termination. Attacks are very severe and typically last from a fraction of a second to 2 min, described as brief, electrical, or shock-like. Pain may be triggered by an innocuous local stimulus such as touching the face, and patients typically avoid washing the face, talking, or chewing so as to avoid triggering an event. There may be a brief refractory period after a triggered event during which triggering further pain is not possible. Remissions may occur in some for long periods of months to years followed by a return of pain. Some patients report a less severe background pain in between attacks.
G50.0 Trigeminal neuralgia
Pathophysiology The trigeminal nerve supplies sensation to the face through three divisions, the ophthalmic (V1), maxillary (V2), and mandibular (V3) divisions. Sensory information from these divisions enters the gasserian ganglion located in Meckel’s cave in the base of the middle cranial fossa. From there,
P. Rizzoli, MD (*) Department of Neurology, Brigham and Women’s/ Faulkner Hospital, 1153 Centre Street, Suite 4H, Boston, MA 02130, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_143
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Those with interictal background pain may be less likely to exhibit neurovascular compression by MRI and may respond less well to medical and surgical management. Rare cases of bilateral trigeminal neuralgia have been described, often in the setting of multiple sclerosis.
Diagnosis ICHD 3-beta 13 Painful cranial neuropathies and other facial pains 13.1 Trigeminal neuralgia 13.1.1 Classical trigeminal neuralgia 13.1.1.1 Classical trigeminal neuralgia, purely paroxysmal 13.1.1.2 Classical trigeminal neuralgia with concomitant persistent facial pain 13.1.2 Painful trigeminal neuropathy 13.1.2.1 Painful trigemina
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