Excruciating pain in the 5th cranial nerve.

May affect any branch of the trigeminal nerve.

Cause is unknown.

Theories: Compression of the trigeminal nerve root.

1. Blood vessel comes in contact with the nerve & causes pressure on it.

2. Inflammation & edema of myelin sheath & demylination of the nerves.

Females > Males

Usually after 50 yrs old.

Pain- mild to excruciating:

Sudden, burning, electrical shock-like, jolting, piercing, lightning-like, shooting, jabbing, like having wires in your face.

Usually comes & goes but may be persistant.

Usually leaves as quickly as it begins.

Usually one side of face (both sides possible).

Facial twitching and tearing.

Patient history.

Dental exam to r/o tooth problems.

MRI, CT to r/o other disorders.

Narcotic analgesics.

Anticonvulsants to reduce pain: Dilantin, tegretol, trileptal.

Baclofen- with anticonvulsants.

Proper dental care.

Used when medical fails or may be combined with medical.

Goal is to destroy sensory portion of nerve:

Alcohol & glycerol injection (not permanent).

Balloon compression- enough pressure applied to destroy nerve (permanent for most).

Electric current- nerve burned out.

Radiation (helps most people).

Severing nerve.

Microvascular decompression relocates or removes blood vessels contacting nerve.

All procedures cause numbness, tingling and often some degree of paralysis.

Some may cause dizziness.

Inspect mouth QD for injury.

Small bites and sips.

Focus on chewing and swallowing.

Chew on unaffected side.

Avoid hot & cold.

Oral care after meals.

Regular dental care.

A temporary weakness or paralysis of the muscles that control expression on one side of the face.

Results from damage to the facial nerve (7th).

Pregnant women.

Patients with DM, influenza, a cold or respiratory illnesses.

Cause is unknown.

Possible VIRAL link.

Develop over hours to days- s/s develop faster the more severe it is.

Pain behind ear prior to paralysis.

Facial pain, numbness & paralysis.

Decreased blink relex, ptosis & tearing on affected side, eyeballs roll up.

Difficulty speaking & chewing.

Based on history & physical exam.

CT, MRI, to r/o CVA, tumor.

EMG to determine extent & severity of damage.

Permanent nerve damage in unusually severe cases.

Tearing.

Eye damage r/t unable to close eye.

80% recover within a few months with or without tx.

Effectiveness of tx uncertain:

Steroids (prednisone)

Antivirals (zovirax, famvir)

Electrotherapy

Rarely done- surgical decompression of nerve

Eye patch/shield to protect affected eye.

Monitor for eye infections or corneal damage.

Saline or abx eye drops as ordered.

Dental care Q6 months.

Monitor for damages to mouth after meals.

A chronic neurological disease characterized by remissions & exacerbations.

Demylination & scarring of various sites along entire CNS white matter.

Remission occurs when there is partial remylinization.

Females > Males

More likely in Caucasians

Cause is unknown.

Probably autoimmune.

Genetic tendency, but not inherited.

Possibly viral, but not infectious.

Many & varied according to site of lesions- lesions scattered thoughout entire CNS

Repeated exacerbations result in increased scarring, therefore increased severity of s/s & increased residual deficits.

Due to lesions on occipital lobe.

Nystagmus (involuntary movement of eyeball)

Diplopia (double vision)

Blurred vision

Blindness eventually

Emotional lability & mood swings r/t lesions on frontal & temporal lobe.

Intellectual, personality, memory & judgment changes r/t lesions on frontal lobe.

Decreased hearing & tinnitus r/t lesions in temporal lobe.

Speech is slurred & hesitant r/t muscle weakness & frontal lobe lesion.

Tremors.

Extremity weakness, numbness, & clumsiness progressing to ataxia (incoordination) then paralysis & spasticity.

Bowel & bladder disfunction: Retention and/or incontinence.

STRESS

HEAT

FATIGUE

EMOTIONAL UPSET

Childbearing

Infection

History & physical exam

No specific test: Tests done to r/o other diseases. Or to collect bits & pieces to confirm.

EMG to evaluate neuromuscular function.

CT, MRI visualizes plaques.

EEG may be slow.

LP: Increased IGG, protein & WBC.

NO CURE.

Treatment is symptomatic & supportive.

Meds: Acute exacerbations- Steroids (IV then PO)

Immunosuppresants (cytoxan)

Muscle spasms (valium, baclofen, dantrium)

Urinary incontenence (ditropan)

Urinary retention (urecholine)

Paresthesis (tegretol, baclofen, neurontin)

Ataxia (steriods, klonipin, neurotin)

Depression r/t disease, meds or coping (elavil)

Fatigue (prozac, amantadine)

Used to reduce severity & frequency of exacerbations.

ABC's of MS- use one:

Avonex

Betaserone

Copaxone

PT & OT

Exercise- gentle stretching & strengthening, avoid rigorous programs.

Bladder disturbances- may need intermittent catheterization, teach aseptic technique.

Skin care importance- preventing pressure ulcers & contractures.

Preserving function as long as possible.

Conserve energy, avoid fatigue & stress.

Balanced, healthy diet.

Monitoring for UTI

Med effects & side effects.

Safety r/t paresthesia & falls r/t weakness, visual issues and balance problems.