Lsu Pa Neurology Gumbo Csm

Front 1

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


vaccinate at age 60 to reduce morbidity
tx with: tricyclic antidepressants, antiepileptics, topical capsaicin cream, topical lidocaine

Back 1

Postherpetic Neuralgia

Front 2

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Older population
The more severe the rash, more likely the complication

Back 2

Postherpetic Neuralgia

Front 3

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Pain with chewing and temperature changes

Back 3

Dental Pains

Front 4

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Elevated ESR (indicates inflammation)

Back 4

Temporal arteritis

Front 5

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis

Progressive pain with mastication
PE reveals tenderness over temporal arteries

Back 5

Temporal arteritis

Front 6

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Jaw claudication, HA, polymyalgia theumatica, and visual abnormalities

Back 6

Temporal arteritis

Front 7

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Pain exacerbated by:
Swallowing, Chewing, Talking, Yawning
May be accompanied by syncope!
vMS is sometimes responsible

Back 7

Glosspharyngeal Neuralgia

Front 8

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis

Occurs in people <40 due to:
Demyelination (MS)
Compression by vascular abnormalities or tumors
(Myeloma, metastatic CA, cholesteatoma, acoustic neuroma)

Back 8

Trigeminal Neuralgia

Front 9

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis


Pain starts at one side of the mouth and radiates toward the ear, eye or nose on ipsilateral side.

Back 9

Trigeminal Neuralgia

Front 10

Differentiate between the following causes of facial pain on the basis of history and physical examination:
a.Trigeminal Neuralgia
b.Glosspharyngeal Neuralgia
c.Postherpetic Neuralgia
d.Dental Pains
e.Temporal arteritis

Pt. c/o sharp, stabbing facial pain

Back 10

Trigeminal Neuralgia

Front 11

Non-pharmacological treatment options for trigeminal neuraglia.

Back 11

1.Microvascular Decompression
a.Drill small hole in skull, lifting brain and placing a pad between the artery and nerve
b.Invasive, less risk of permanent numbness
2.Radiofrequency Surgery (rhizotomy)
a.Side Effect of permanent numbness
b.Elderly population
3.Alcohol injection of the affected nerve
a.Repeated q6 months
4.Gamma radiosurgery
a.80% successful
b.Facial paresthesias
5.Posterior Fossa Exploration
a.Reveals structural causes not found on imaging
b.Inappropriate in patients with TN from MS.

Front 12

Describe typical presentation of Tuberous Sclerosis

Back 12

i.Seizures
ii.Progressive psychomotor retardation beginning in early childhood
iii.Hypomelanotic skin macules
iv.Shagreen patches
v.Subungual fibromas
vi.Facial angiofibromas (adenoma sebaceum) – reddened nodules that appear at 5-10 years of age
vii.Associated abnormalities:
1.Retinal lesions/tumors (hamartomas are seen ophthalmoscopically in approx. 50% of patients)
2.Subependymal nodules or cortical tubers
3.Cardiac rhabdomyomas
4.Lung cysts, benign tumors or viscera, bone cysts

Front 13

Describe typical presentation of Neurofibromatosis I = “von Recklinhausen disease”

Back 13

1.Multiple hyperpigmented macules and neurofibromas
2.Chromosome 17
3.Clinical criteria – Must include 2 or more:
a.Six or more café au lait macules >5mm prepuberty and > 15mm postpuberty
b.2 or more neurofibroma of any type (or 1 plexiform neurofibroma)
c.Axillary or inguinal freckling
d.Sphenoid bone dysplasia
e.Optic pathway glioma
f.Lisch nodule (iris hamartoma)
g.Family hx of NF1
4.Other manifestations:
a.Learning disabilities, seizures, mental retardation
b.Neuroimaging shows:
c.Nerve sheath tumors
d.Optic gliomas
e.Brain stem, cerebellar, and basal ganglia foci of demyelination

Front 14

Describe typical presentation of Neurofibromatosis II

Back 14

1.Eighth nerve tumors, other intracranial or intraspinal tumors
2.Chromosome 22
3.Less common than NF type 1
4.Bilateral 8th cranial nerve (Vestibulocochlear) Schwannomas
a.Causes HA, dizziness, vertigo, hearing loss (Hallmark sign ~age 20)
5.30% of patients have neurocutaneous manifestations

Front 15

Describe typical presentation of Sturge-Weber Syndrome

Back 15

i.Manifested at birth – unilateral port wine stain on forehead and upper eyelid
ii.Cutaneous capillary angioma – suggests angiomatosis of pia mater
iii.Hemiparesis/plegia of the face/eyelid
iv.Infantile seizures frequently with hemiconvulsions of contralateral side
v.Rare, congenital (sporadic occurrence)
vi.Essentially caused by persistent embryonal vascular plexus.