Trigeminal Neuralgia and Giant Cell Arteritis
Demographics:
Trigeminal neuralgia: can occur at any age but is more common in patients who are 50 or older (NIH,
2019). The incidence for this condition is 12 per 100, 000 population. Women are most affected. Giant
cell arteritis is also seen most commonly in patients 50 and over but the average age onset is 75
(Gossman, Peterfy, & Khazaeni, 2019). Women are most affected.
Giant cell arteritis is rare, only affecting 10 to 20 people a year (Gossman, Peterfy, & Khazaeni, 2019).
The condition affects all ethnicities, but patients of European descent have a tendency to get the
condition. When it comes to epidemiology the only difference is that giant cell arteritis is rare.
Risk Factors
Trigeminal Neuralgia: Women and older adults are affected more often (Buttaro, Trybulski, Polgar-Bailey,
& Sandburg-Cook, 2017, p. 1063)
Giant cell arteritis: Patient 50 years or older, women, and Caucasian (Buttaro, Trybulski, Polgar-Bailey, &
Sandburg-Cook, 2017, p. 1162). The more advanced the age the greater the risk.
Onset of symptoms
Trigeminal Neuralgia: Patient will come into the office with pain that feels as burning, sharp,
penetrating, or an electric shock on one side of the face (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-
Cook, 2017, p. 1063). The pain will stop patient from any activity they are doing like eating or talking.
Giant cell arteritis: Patient complaints of a headache with visual disturbance in some cases like blurry
vision. The patient may also complaint of jaw pain when chewing. Other more general symptoms
described by the patient may be fever, anorexia, night sweats, cough, and weight loss (Buttaro, Trybulski,
Polgar-Bailey, & Sandburg-Cook, 2017, p. 1162). The two conditions present differently when compared
side by side.
Pathophysiology (knowledge demonstrated in original dialogue)
Trigeminal Neuralgia: The fifth cranial nerve is called the trigeminal nerve and it has sensory and motor
functions (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017, p. 1063) The function can be further
separated into ophthalmic or v1, maxillary or v2, and mandibular or v3. The trigeminal nerve goes from
the brain stem to different parts of the face including the cornea, mouth and nose. Most cases of this
condition are due to vascular compression and are termed classic trigeminal neuralgia. The condition can
also be caused by multiple sclerosis and trauma. Secondary trigeminal neuralgia is of unknown cause.
The nerve can sometimes be compressed by cerebral arteries.
Giant cell arteritis occurs when there is an inflammatory process in the aorta or carotid and its branches
(Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017, p. 1162). The cause is unknown, but the
inflammation occurs in all layers of the artery causing occlusion. During that process a predominance of
mononuclear infiltrates or granulomas with multinucleated giant cells are seen on the site. Some of the
sites for this process can include the carotid artery and its branches. As seen above trigeminal neuralgia
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, is due to nerve compression while giant cell arteritis is an inflammation that leads to occlusion of the
artery.
Assessment (physical assessment, diagnostic testing)
Trigeminal Neuralgia: The patient will describe an electric shock like pain that can last a fraction of a
second or more. The pain is usually unilateral but can rarely be bilateral. V3 and V2 are usually involved
but when V1 is also included symptoms like diplopia, blurry vision, and lacrimation can be seen (Shankar
Kikkeri, 2020). The patient will have trigger zones that when touched or stimulated will produce the
symptoms. The patient is aware of the zones and will avoid stimulation. Men may be seen with hair
patches on their beard because shaving the area will trigger symptoms. Brushing teeth, washing face,
and chewing are other triggers the provider can ask about and will help narrow the differential diagnosis
(Shankar Kikkeri, 2020). Physical examination should include head, neck, eyes, ears, teeth, mouth, and
temporomandibular to rule out other conditions (Shankar Kikkeri, 2020). The provider should be able to
find the triggers zones. In the patient with classic Trigeminal neuralgia the neurological and physical
examination is normal. If neurological changes are seen like sensory loss the provider must consider
secondary trigeminal neuralgia, which is an emergency.
Common complaints for giant cell arteritis include headache, vision loss, jaw claudication, fever, fatigue,
anorexia, and temporal tenderness (Gossman, Peterfy, & Khazaeni, 2019). Patients may have been
experiencing the headache for 2-3 months. Headache worsens with exposure to cold temperatures or
pressure from the pillow exerted on the artery. During the physical examination the provider may notice
thickening of the temporal artery with pain, erythema, or nodular skin around the area. The patient with
giant cell arteritis may show symptoms of TIA or stroke (Gossman, Peterfy, & Khazaeni, 2019). If there is
optical nerve compression, pupillary symptoms may be seen. The diagnosis of the condition is more
complicated if the site of compression is other than the temporal artery.
Diagnosis
Trigeminal neuralgia is diagnosed based on symptoms or trigger points reported by the patient
(Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). Other conditions that can cause pain must be
ruled out like tooth decay. Onset of pain is important because it can tell the provider if is related to a
condition. A good example is if the pain is preceded by the herpes zoster rash than it can be attributed to
it (Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). The location can also point to the cause (e. pain
coming from teeth). MRI of brain and brain stem is done to exclude causes like tumors or multiple
sclerosis (Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). Laboratory testing like electrolytes, renal,
and liver are useful to have before starting treatment. ECG is also needed before starting treatment.
Giant cell arteritis is diagnosed with a temporal artery biopsy showing vascularitis with mononuclear cell
infiltrates with giant cells (Nesher & Breuer, 2016). Lab test also help with diagnosis including CBC, ESR,
and c-reactive protein to look for inflammation and anemia. Utrasonography, MRI, and PET scans can
help get a more general view of other vessels including the ones in the chest and brain but are not
commonly used (Nesher & Breuer, 2016). This may help detect inflammation in greater vessels, but the
biopsy confirms the diagnosis and is seen as the gold standard.
Treatment
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Demographics:
Trigeminal neuralgia: can occur at any age but is more common in patients who are 50 or older (NIH,
2019). The incidence for this condition is 12 per 100, 000 population. Women are most affected. Giant
cell arteritis is also seen most commonly in patients 50 and over but the average age onset is 75
(Gossman, Peterfy, & Khazaeni, 2019). Women are most affected.
Giant cell arteritis is rare, only affecting 10 to 20 people a year (Gossman, Peterfy, & Khazaeni, 2019).
The condition affects all ethnicities, but patients of European descent have a tendency to get the
condition. When it comes to epidemiology the only difference is that giant cell arteritis is rare.
Risk Factors
Trigeminal Neuralgia: Women and older adults are affected more often (Buttaro, Trybulski, Polgar-Bailey,
& Sandburg-Cook, 2017, p. 1063)
Giant cell arteritis: Patient 50 years or older, women, and Caucasian (Buttaro, Trybulski, Polgar-Bailey, &
Sandburg-Cook, 2017, p. 1162). The more advanced the age the greater the risk.
Onset of symptoms
Trigeminal Neuralgia: Patient will come into the office with pain that feels as burning, sharp,
penetrating, or an electric shock on one side of the face (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-
Cook, 2017, p. 1063). The pain will stop patient from any activity they are doing like eating or talking.
Giant cell arteritis: Patient complaints of a headache with visual disturbance in some cases like blurry
vision. The patient may also complaint of jaw pain when chewing. Other more general symptoms
described by the patient may be fever, anorexia, night sweats, cough, and weight loss (Buttaro, Trybulski,
Polgar-Bailey, & Sandburg-Cook, 2017, p. 1162). The two conditions present differently when compared
side by side.
Pathophysiology (knowledge demonstrated in original dialogue)
Trigeminal Neuralgia: The fifth cranial nerve is called the trigeminal nerve and it has sensory and motor
functions (Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017, p. 1063) The function can be further
separated into ophthalmic or v1, maxillary or v2, and mandibular or v3. The trigeminal nerve goes from
the brain stem to different parts of the face including the cornea, mouth and nose. Most cases of this
condition are due to vascular compression and are termed classic trigeminal neuralgia. The condition can
also be caused by multiple sclerosis and trauma. Secondary trigeminal neuralgia is of unknown cause.
The nerve can sometimes be compressed by cerebral arteries.
Giant cell arteritis occurs when there is an inflammatory process in the aorta or carotid and its branches
(Buttaro, Trybulski, Polgar-Bailey, & Sandburg-Cook, 2017, p. 1162). The cause is unknown, but the
inflammation occurs in all layers of the artery causing occlusion. During that process a predominance of
mononuclear infiltrates or granulomas with multinucleated giant cells are seen on the site. Some of the
sites for this process can include the carotid artery and its branches. As seen above trigeminal neuralgia
This study source was downloaded by 100000804166229 from CourseHero.com on 06-09-2022 07:58:19 GMT -05:00
https://www.coursehero.com/file/62364097/Trigeminal-Neuralgia-and-Giant-Cell-Arteritis-week-1docx/
, is due to nerve compression while giant cell arteritis is an inflammation that leads to occlusion of the
artery.
Assessment (physical assessment, diagnostic testing)
Trigeminal Neuralgia: The patient will describe an electric shock like pain that can last a fraction of a
second or more. The pain is usually unilateral but can rarely be bilateral. V3 and V2 are usually involved
but when V1 is also included symptoms like diplopia, blurry vision, and lacrimation can be seen (Shankar
Kikkeri, 2020). The patient will have trigger zones that when touched or stimulated will produce the
symptoms. The patient is aware of the zones and will avoid stimulation. Men may be seen with hair
patches on their beard because shaving the area will trigger symptoms. Brushing teeth, washing face,
and chewing are other triggers the provider can ask about and will help narrow the differential diagnosis
(Shankar Kikkeri, 2020). Physical examination should include head, neck, eyes, ears, teeth, mouth, and
temporomandibular to rule out other conditions (Shankar Kikkeri, 2020). The provider should be able to
find the triggers zones. In the patient with classic Trigeminal neuralgia the neurological and physical
examination is normal. If neurological changes are seen like sensory loss the provider must consider
secondary trigeminal neuralgia, which is an emergency.
Common complaints for giant cell arteritis include headache, vision loss, jaw claudication, fever, fatigue,
anorexia, and temporal tenderness (Gossman, Peterfy, & Khazaeni, 2019). Patients may have been
experiencing the headache for 2-3 months. Headache worsens with exposure to cold temperatures or
pressure from the pillow exerted on the artery. During the physical examination the provider may notice
thickening of the temporal artery with pain, erythema, or nodular skin around the area. The patient with
giant cell arteritis may show symptoms of TIA or stroke (Gossman, Peterfy, & Khazaeni, 2019). If there is
optical nerve compression, pupillary symptoms may be seen. The diagnosis of the condition is more
complicated if the site of compression is other than the temporal artery.
Diagnosis
Trigeminal neuralgia is diagnosed based on symptoms or trigger points reported by the patient
(Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). Other conditions that can cause pain must be
ruled out like tooth decay. Onset of pain is important because it can tell the provider if is related to a
condition. A good example is if the pain is preceded by the herpes zoster rash than it can be attributed to
it (Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). The location can also point to the cause (e. pain
coming from teeth). MRI of brain and brain stem is done to exclude causes like tumors or multiple
sclerosis (Maarbjerg, Di Stefano, Bendtsen, & Cruccu, & 2017). Laboratory testing like electrolytes, renal,
and liver are useful to have before starting treatment. ECG is also needed before starting treatment.
Giant cell arteritis is diagnosed with a temporal artery biopsy showing vascularitis with mononuclear cell
infiltrates with giant cells (Nesher & Breuer, 2016). Lab test also help with diagnosis including CBC, ESR,
and c-reactive protein to look for inflammation and anemia. Utrasonography, MRI, and PET scans can
help get a more general view of other vessels including the ones in the chest and brain but are not
commonly used (Nesher & Breuer, 2016). This may help detect inflammation in greater vessels, but the
biopsy confirms the diagnosis and is seen as the gold standard.
Treatment
This study source was downloaded by 100000804166229 from CourseHero.com on 06-09-2022 07:58:19 GMT -05:00
https://www.coursehero.com/file/62364097/Trigeminal-Neuralgia-and-Giant-Cell-Arteritis-week-1docx/
