Trigeminal Neuralgia

Sharp

Step 1: View clinicals

A 34 year old man presents with multiple episodes of intense, sharp, right-sided facial pain which last for about a minute and occur around ten times a day; these first started 2 months ago. The pain is worst over the nasolabial groove and is precipitated by brushing his teeth, shaving, washing his face, eating, and talking. His medical and surgical histories are unremarkable.


Step 2: Order all relevant investigations

MRI + MRA Brain

The brain and intracranial vasculature appear normal.

Nerve Biopsy

You realize that a nerve biopsy is probably not indicated here.

Lumbar Puncture

The CSF analysis is within normal parameters.

Liver Function Tests

Total protein: 5.1 g/dL (6.3 - 7.9) AST: 56 U/L (8 - 48) ALT: 78 U/L (7 - 55) PT: 10.2 s (9.5 - 13.8) Bilirubin: 0.9 mg/dl (0.1 - 1.0)


Step 3: Select appropriate management

Carbamazepine
Sumatriptan
Surgery
Valacyclovir


Score: ★★☆