Etiology, Presentations, and Differential Diagnoses

Etiology, Presentations, and Differential Diagnoses

            The trigeminal nerve, which originates in the ear and extends to the upperface, cheeks, and lower jaw causes trigeminal neuralgia (Cha & Son, 2020). Pain from this illness often only affects one side of the face and can be brought on by activities like eating or tooth cleaning. Trigeminal neuralgia can occasionally worsen, with fewer days without pain as it progresses. It may be confused with a variety of other potential diagnoses that result in facial pain, such as infection, TMJ dysfunction, cluster headaches, and postherpetic neuralgia, which follows shingles.

Typical Diagnostic Work-Up

As there is no particular test for TN, the diagnosis is mostly dependent on the symptoms and pain-related descriptions provided by the patient. To rule out other, more frequent causes of face discomfort, a doctor may inquire about the symptoms and do a dental X-ray (Greve et al., 2020). To determine whether the problem has an underlying cause, an MRI scan might also be requested.

Treatment Plan and Tertiary Prevention Measures

For those with idiopathic and classic TN, pharmaceutical therapy is the initial line of treatment. The anticonvulsant medicine carbamazepine is the most often prescribed drug (Cha & Son, 2020). Trigeminal neuralgia development prevention recommendations are presently unavailable. However, those who already have the illness may be able to avoid episodes and discomfort by keeping track of probable triggers.

Appropriate Referrals/Consultations

Trigeminal neuralgia can be diagnosed and treated initially by a primary care physician, but general neurology consultations may be required to rule out potential secondary causes such as sclerosis, chronic venous insufficiency, and cerebellopontine tumor (Greve et al., 2020). Patients who are resistant to medication therapy should consult with a neurosurgeon or neurovascular surgeon to determine whether microvascular decompression as well as other surgical procedures are necessary.

Considerations Forthe Geriatric Population

Age-related and co-morbid diseases are frequently prevalent in elderly individuals, necessitating polypharmacy. Antiepileptic medications frequently interact with other medications (Raygor et al., 2019). As a result, developing a drug intervention for TN in the elderly that does not alter pharmacodynamics and pharmacokinetics or raise safety concerns is difficult.

References

Cha, J., & Son, B. (2020). Idiopathic Trigeminal Neuralgia Misdiagnosed as Secondary Trigeminal Neuralgia Caused by Neurogenic Tumor in the Infratemporal Fossa: A Case Report. The Nerve, 6(2), 100–104. https://doi.org/10.21129/nerve.2020.6.2.100