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Question
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Which statement is not true regarding trigeminal neuralgia?
Explanation
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Almost 99% of patients report a trigger with provocation of pain by an innocuous trigger like touch, chewing etc. Patients may have a refractory period where repeated stimulation may fail to induce the pain. Neurovascular compression in the root entry zone- a few millimeters before it enters the pons is the accepted pathology, but a study showed neurovascular compression without symptoms in normal individuals. Familial cases have been seen in 10%, some with hereditary neuropathy such as Charcot-Marie-Tooth disease or mutation in Nav1.6, they have earlier onset and other associated neuralgias. Microvascular decompression in the presence of a vascular loop provides the highest relief of 70-88%
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Reference
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Robertson C. Cranial Neuralgias. Continuum 2021 27(3 Headache)665-685.
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Option 1
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Is Correct (Option 1):
50% of patients will report a trigger
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Option 2
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Is Correct (Option 2):
Neurovascular compression may occur without symptoms
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Option 3
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Is Correct (Option 3):
Familial cases may be seen in 11%
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Option 4
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Is Correct (Option 4):
The highest probability of pain relief is with microvascular decompression
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