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Neuro Quiz # 75. Quiz Team ... A: The trigeminal nerve is made up of three branches: the ... C: TN is a result of irritation of cranial nerve V, most.
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Neuro Quiz # 75 Quiz Team Suneeta Gollapudy, MD Shobana Rajan, MD Marie Angele Theard, MD Hui Yang, MD PhD Verghese T Cherian, MD, FFARCSI Professor, Penn State University College of Medicine Hershey, PA Acknowledgment for Contribution: Amir Mohajerani, MD Neuro-Anesthesia Fellow Cleveland Clinic Hospital
Question 1: Anatomy Question 2: Pathophysiology Question 3: Management Question 4: Neuromonitoring Please click on any of the following links to proceed to that question/topic. Question 5: Neuromonitoring Trigeminal Neuralgia TITLE SLIDE
A. The trigeminal nerve is made up of three branches: the oculomotor, the maxillary & the mandibular The first branch is ‘Ophthalmic’, and not Oculomotor nerve Oculomotor is the cranial nerve III Next Question Ophthalmic Maxillary Mandibular
B. The sensation from the face is relayed in the Gasserian ganglion that is located outside the brain stem This is correct. The trigeminal ganglion or Gasserian ganglion is located in the Meckel’s cave and the three branches Ophthalmic, Maxillary and Mandibular, arise from it. (^) Click to Return to Question Foramen Ovale – Mandibular N Foramen Rotundum – Maxillary N Superior Orbital Fissure – Ophthalmic N Meckel’s cave
D. It divides into three branches each of which exits the cranium through different foramens The three branches of the trigeminal nerve separate from the trigeminal ganglion and exit the cranium through three separate foramens Superior orbital fissure – Ophthalmic N Foramen rotundum – Maxillary N Foramen ovale – Mandibular N Click to Return to Question Foramen Ovale – Mandibular N Foramen Rotundum – Maxillary N Superior Orbital Fissure – Ophthalmic N Meckel’s cave
Which of the following statements about the patho-physiology of Trigeminal neuralgia (TN) is TRUE? A: TN presents as sharp pain over the face and is usually bilateral B: The pain often leaves the patient with uncontrollable facial twitching C: TN is a result of irritation of cranial nerve V, most commonly precipitated by facial injury or a tumor D: The compression of the nerve as it exits the cranium is a likely cause of TN
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B. The pain often leaves the patient with uncontrollable facial twitching After a bout of pain, the face may twitch uncontrollably Next Question
C. TN is a result of irritation of cranial nerve V, most commonly precipitated by facial injury or a tumor TN can be caused by vascular compression and/or multiple sclerosis which cause deterioration of the myelin sheath Neuropathic facial pain may rarely be caused by overlying tumor or injury Click to Return to Question
A: The diagnosis is mainly clinical as the presentation of TN is very typical B: A radiofrequency electrode is passed through a fine burr hole in the temporal bone to ablate the trigeminal ganglion C: Surgical management of TN is usually reserved for those who do not respond to medications D: The mainstay of treatment of TN is anti-inflammatory medications
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A. The diagnosis is mainly clinical as the presentation of TN is very typical Although, TN presents with sharp, hemifacial pain, other causes for facial pain including post-herpetic neuralgia, cluster headaches, and temporomandibular joint disorder must be ruled out Most people with TN may eventually undergo an MRI scan to rule out a tumor or multiple sclerosis as the cause of their pain, if they do not respond to medical treatment. This scan may show a blood vessel compressing the nerve. Special MRI imaging procedures can reveal the presence and severity of compression of the nerve by a blood vessel. Click to Return to Question
C. Surgical management of TN is usually reserved for those who do not respond to medications The mainstay of managing TN is pharmacological. Surgery is considered if it fails or for tumor or micro vascular decompression. Next Question
D. The mainstay of treatment of TN is anti-inflammatory medications The mainstay of medical treatment for TN is anti-convulsant medication, such as carbamazepine, lamotrigine, or gabapentin. Acetaminophen or non-steroidal anti-inflammatory drugs may be used to relieve acute pain Click to Return to Question
A. Orbicularis Oculi Orbicularis Oculi is supplied by Facial N (VII) Click to Return to Question
B. Muscles of the tongue All the intrinsic muscles of the tongue are supplied by the Hypoglossal N (XII) All the extrinsic muscles of the tongue are supplied by Hypoglossal N, except Palatoglossus, which is supplied by Vagus N (X) Click to Return to Question
