Facial Pain And Sensory Loss

EXAMINATION OF TRIGEMINAL NERVE FUNCTION.

This should include examination of the corneal reflex and masticatory muscle function (page 14).

Divisional -root or peripheral

Note pattern (i-e- V,, V2 or V3) nerve lesion sensory loss or

'onion skin' -brainstem lesion

Note the type of sensory loss

Note the presence of limb motor and/or sensory signs

Dissociated sensory loss (i.e. pain and temperature sensation lost, touch retained)

Without cranial nerve palsies

-favours an intrinsic brainstem lesion, but does not exclude a cerebellopontine angle mass, causing brainstem distortion

—supratentorial lesion

CAUSES OF V NERVE LESIONS Pons

When associated with other cranial nerve lesions and long tract signs:

- vascular

- neoplastic

- demyelination

- syringobulbia (especially dissociated __

sensory loss) n

(Tentorium cerebelli omitted)

Petrous apex associated VI nerve palsy - petrositis (Gradenigo's syndrome)

Orbital fissure Orbit

Cavernous sinus

First division of V nerve + III, IV and VI nerve palsies

Petrous apex associated VI nerve palsy - petrositis (Gradenigo's syndrome)

Orbital fissure Orbit

Cavernous sinus

First division of V nerve + III, IV and VI nerve palsies

-'V One or more V divisions involved:

- nasopharyngeal or metastatic carcinoma

- trauma (e.g. infraorbital nerve - malar fracture)

Other causes Cerebello-pontine angle

- diabetes When associated with other cranial

- SLE nerve lesions ± long tract signs:

acoustic neuroma trigeminal neuroma subacute (chronic) meningitis

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