Trigeminal Neuralgia

What causes trigeminal neuralgia?

Introduction | Types | Symptoms | Causes | Diagnosis | Treatments

Introduction

•The brain is connected to the body by the spinal cord with spinal nerves sending and receiving impulses and messages to and from the brain.

•However, twelve cranial nerves directly connect to the body. These nerves are involved with the muscle and sensory function of the head and neck.

 

•Trigeminal Nerve, also known as the 5th cranial nerve.

•Primarily provides sensation to the face.

•Smaller role in muscle for chewing and biting.

•The trigeminal nerve is so named because it has three (tri) branches responsible for facial sensation.

1- Ophthalmic (V1) 

2- Maxillary (V2) 

3- Mandibular (V3)

•Fothergill’s Disease (FD) also known as Trigeminal Neuralgia is characterized by paroxysmal attacks of severe, sharp, stabbing, electric shock-like pain affecting one side of the face mainly the second and third divisions of it.

 

•Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve.

•The pain of trigeminal neuralgia is may occur every few hours, minutes, or seconds, but in some patients whose pain is not well controlled affecting activities of daily life and cause depression.

 

Types

There are two main types:

1- Typical

2- Atypical trigeminal neuralgia.

 

Typical Trigeminal Neuralgia

•The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes.

 

Atypical Trigeminal Neuralgia

•The atypical form results in a constant burning pain that is less severe

 

 

Symptoms

•Sever shooting pain may feel like ha electric shock at the nerve root.

•Sudden attack of pain and get worsen by touching the face, chewing.

•Duration of pain lasts from a few seconds to several minutes.

•Pain in the areas where trigeminal nerve supplies go, cheek, jaws, teeth, gums, lips.

•Pain occurs one side of the face at a time.

 

Causes

•Multiple Sclerosis.

•Tumors on the nerve.

•Compression of the nerve by the small artery or vein.

•Old age. 

•Diabetes.

 

Most Common cause:

•Vascular Compression of the nerve by a small leaves the brainstem.

 

Diagnosis

•From a well-taken history 

•CT- scan

•MRI

 

Medical Treatment

Carbamazepine:-

•This medicine slows the nerve firing and can quiet an overaction nerve. Other Solutions:

•Injection of glycerol into the nerve.

 

Physical therapy Treatment

•Patients were given continuous Transcutaneous Electrical Nerve Stimulation (TENS) at 250 Hz with a pulse of 120 u for 20 minutes five days a week for four weeks over the route of the afflicted nerve. One electrode was put immediately before the ear, while the other was implanted near the nerve's end. When necessary, however, the location was adjusted to accommodate pain referral and effectiveness.

•A heated moist pack was applied to the neck and trapezius muscle for at least 10 minutes to treat muscle spasms.

•For five repetitions, isometric neck exercises for each side were administered, as well as pain-free neck range of motion exercises (neck flexion, extension, and side-bending).

•For ten minutes, relaxation techniques were used, including deep breathing exercises.

•Patients were instructed to cover the injured side of their face with a soft cloth or a cotton pad for 15 minutes each day to lessen hypersensitivity, which may aid in reducing the nervous system's exposure to continual afferent input.

 

Surgery

• The surgeon Cut the Skull behind the ear through a small 2- inch incision and 1- inch opening in the bone.

• Once found, the vessel is moved aside and a small piece of padding is placed to keep the vessel off the nerve.

• Often, a small grove is seen in the nerve where the vessel was compressing it.

 

 

 

Muscular Dystrophy, Types of Muscular dystrophy

Defination | Types | Symptoms | Diagnosis | Treatment

What is muscular dystrophy?

Muscular dystrophy refers to a set of hereditary disorders that cause muscular degeneration and weakness over time. The lack of a protein called dystrophin, which is required for optimal muscular function, causes this damage and weakening. Walking, swallowing, and muscular coordination can all be affected by a lack of this protein. 

Muscular dystrophy can strike at any age, however it is most commonly diagnosed in children. This disorder is more common in young boys than in young girls.

 

What are the Types and symptoms of muscular dystrophy?

There are nine different groups.

Duchenne muscular dystrophy

This is the most frequent kind of muscular dystrophy in children. Boys make up the vast majority of those impacted. It's uncommon for females to develop it. Among the signs and symptoms are:

•Trouble walking

•loss of reflexes

•Difficulty in standing up

•Poor posture

•Lungs and heart weakness

•Swallowing difficulty

•Bone thinning

•Scoliosis:- (which is an abnormal curvature of your spine)

•Breathing difficulties

 

Becker muscular dystrophy

Becker muscular dystrophy is a type of muscular dystrophy that is comparable to Duchenne muscular dystrophy but is less severe. Boys are more typically affected by this kind of muscular dystrophy. Muscle weakness is most common in the arms and legs, and symptoms usually begin between the ages of 11 and 25.

Other Becker muscular dystrophy symptoms include: 

 

•Walking on your toes

•Muscle spasms 

•Frequent falls 

•Having difficulty getting up from the floor

 

Myotonic dystrophy

Steinert's disease or dystrophia myotonica are other names for myotonic dystrophy. Myotonia, or the inability to relax your muscles after they contract, is a symptom of this type of muscular dystrophy. This kind of muscular dystrophy is the only one that causes myotonia.

Myotonic dystrophy can affect your: 

•Facial muscles

•Central nervous system (CNS)

•Adrenal glands

•Heart

•Thyroid

•Eyes

•Gastrointestinal tract (GIT)

Symptoms most often appear first in your neck and face. They include:

•Drooping of muscles in your face, producing a thin, haggard look

•Difficulty in lifting your neck due to weaken neck muscles

•Difficulty during swallowing

•Dropping of  eyelids, or ptosis

•Early baldness in the front area of your scalp (Head)

•Poor in vision

•Weight loss

•Increased sweating

Males with this form of dystrophy may experience impotence and testicular atrophy. It can induce irregular periods and infertility in women. 

Adults in their 20s and 30s are the most likely to be diagnosed with myotonic dystrophy. Symptoms might range from mild to severe. Some people have moderate symptoms, while others have symptoms involving the heart and lungs that could be life-threatening.

 

Congenital muscular dystrophy

Between the ages of birth and two, congenital muscular dystrophies are frequently visible. This is when parents observe that their child's motor skills and muscle control aren't progressing as they should. Symptoms can include any of the following:

 

•Muscle weakness

•Poor motor control (PMC)

•Inability to sit or stand without support

•Scoliosis

•Foot deformities

•Trouble in swallowing

•Respiratory problems

•Vision problems

•Problems in speech

 

Facioscapulohumeral (FSHD)

Landouzy-Dejerine disease is another name for Facioscapulohumeral muscular dystrophy (FSHD). The muscles in your face, shoulders, and upper arms are affected by this type of muscular dystrophy. FSHD can lead to:

•Slanted shoulders 

•Crooked appearance of the lips 

•Wing-like aspect of the shoulder blades •Difficulties chewing or swallowing

Hearing and respiratory difficulties affect a tiny percentage of patients with FSHD. 

The progression of FSHD is usually sluggish. Symptoms typically occur throughout your adolescent years, however they might even appear in your 40s. The majority of patients with this illness survive to be 100 years old.

 

Limb-girdle muscular dystrophy

Muscle weakness and loss of mass are symptoms of limb-girdle muscular dystrophy. Muscular dystrophy of this type usually starts in the shoulders and hips, although it can also affect the legs and neck. If you have limb-girdle muscular dystrophy, it may be difficult to get out of a chair, move up and down stairs, or carry heavy goods. You may also be more prone to stumbling and falling. 

Males and females are both affected by limb-girdle muscular dystrophy. By the age of 20, the majority of people with this type of muscular dystrophy are completely crippled. Many, on the other hand, have a normal life expectancy.

 

Oculopharyngeal muscular dystrophy (OPMD)

Facial, neck, and shoulder muscles become weak as a result of oculopharyngeal muscular dystrophy. Other signs and symptoms include:

 

•Eyelids that are drooping 

•Vocal changes are difficult to swallow 

•Issues with vision 

•Issues with the heart 

•Walking difficulties 

•Both men and women can develop OPMD. •Diagnoses are most common in people in their 40s and 50s.

 

Distal muscular dystrophy

Distal myopathy is another name for distal muscular dystrophy. It has an impact on the muscles in your: 

•Forearms

•Hands

•Calves

•Feet 

It may also have an impact on your lungs and heart muscles. The symptoms, which include:

 

•A loss of fine motor skills 

•Trouble walking, tend to advance slowly. Between the ages of 40 and 60, the majority of persons, both male and female, are diagnosed with distal muscular dystrophy.

 

Emery-Dreifuss muscular dystrophy

Emery-Dreifuss muscular dystrophy is more common in boys than it is in girls. Muscular dystrophy of this sort usually begins in childhood. Among the signs and symptoms are: 

 

•Muscle weakness in your upper arm and lower leg 

•Breathing difficulties 

•Issues with the heart 

•Muscle shortening in the spine, neck, ankles, knees, and elbows 

The majority of people with Emery-Dreifuss muscular dystrophy die in their forties or fifties from heart or lung failure.

 

How is muscular dystrophy diagnosed?

A variety of tests can be used to assist your doctor diagnose muscular dystrophy. Your doctor may be able to: 

 

•Look for enzymes generated by injured muscles in your blood. 

•Check your blood for muscular dystrophy genetic markers. 

•Using an electrode needle that is inserted into your muscle, do an electromyography test on the electrical activity of your muscle. 

•Perform a muscle biopsy to check for muscular dystrophy in a sample of your muscle.

•Muscle inflammation (myositis) or muscular damage owing to muscle diseases can be detected using a creatine kinase (CK) 

How is muscular dystrophy treated?

Although there is no cure for muscular dystrophy, medicines can help you manage your symptoms and decrease the disease's course. Treatment options are determined by your symptoms. 

 

There are several treatment options available, including: 

 

•Corticosteroid medicines, which aid to build your muscles and slow down the degradation of your muscles. 

•If your respiratory muscles are affected, you may need assisted ventilation. 

•If you have heart problems, you may need medication. 

•Surgery to help correct muscle shortening •Surgery to repair cataracts 

•Surgery to treat scoliosis 

•Surgery to treat cardiac problems 

Therapy has been shown to be beneficial. Physical therapy can help you maintain your range of motion and strengthen your muscles. Occupational therapy can assist you in the following ways: 

 

•Become more self-reliant and increase your coping abilities 

•Enhance your social abilities 

•Access to community resources