Neuralgia
In a patient diagnosed with trigeminal neuralgia what traditionally prescribed pain medications are not usually effective, and what would be other options for pharmacotherapy as first line?
Opioids are shown to be ineffective,
arbamazepine or oxcarbazepine are first line typically.
https://thejns.org/view/journals/j-neurosurg/131/6/article-p1805.xml
What nervous system complication is common in those with hypothyroid especially if it is not well controlled for long periods of time?
Peripheral neuropathy is a common complication of hypothyroid.
What is another cause of headache that also causes "the worst pain of someone's life" and is associated with trauma with peak of symptoms shortly after onset?
Which part of the patient's history is most likely indicative of a cause for her poor dental history?
20 pack year history of smoking.
https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html
The alternate name of the patient's most likely diagnosis is _______?
What viruses are most often associated with different forms of trigeminal nerve pain?
VZV, HSV, and EBV are common viral causes of trigeminal nerve pain.
https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
What finding from this patient's history is especially unusual given her history of hypothyroidism and may be alarming in her given this history?
In which other common presentation of Headache is the trigeminal nerve extensively involved? What molecule is released here to elicit this pain?
Migraine and CGRP
What other test outside of the main complaint would be recommended for the patient based on her #1 risk factor for her poor dental health?
The patient has a 20 pack year history and is over 50 years of age meaning a chest X-ray for lung cancer would be recommended.
https://www.cdc.gov/cancer/lung/basic_info/screening.htm
What is one of the patient's previous risk factors that put her at risk for depression excluding her current complaint? What was one clue that her risk factor may not have been well controlled?
Hypothyroidism which has been shown to be linked to depression especially if not well controlled over long periods of time.
Patient showed some level of cold intolerance showing her hypothyroid may not be well controlled.
Samuels MH.Psychiatric and cognitive manifestations of hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):377–383.
What is a possible surgical innervation for treatment of Trigeminal Neuralgia?
What is a syndrome associated mostly with pregnancy/postpartum state that could lead to symptoms of intense headached, vomiting, and eventual hypothyroidism?
Lymphocytic Hypophysitis.
What component of the patient's family history could be a risk factor for her poor dental history? Why is this?
Father who died of esophageal cancer which has Barrett Esophagus as a possible cause. Barrett esophagus has been shown to have familial links and risk factors.
https://academic.oup.com/gastro/article/1/1/9/575881?login=false
What famous drummer has been diagnosed with TRigeminal Neuralgia?
(Hint: THe band he drummed for has to do with the Eye)
Travis Barker!
THe drummer for BLINK 182
What is the typical mechanism by which trigeminal neuralgia occurs?
Typically through a compression of the nerve by an aberrant loop of the intracranial artery?
What is the number one infectious etiology of dental carries?