D rehabilitation will be needed to minimize the effects of the resulting

D rehabilitation will be needed to minimize the

This preview shows page 51 - 53 out of 92 pages.

D. rehabilitation will be needed to minimize the effects of the resulting neurological insult.
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Answer A. numerous studies have demonstrated a benefit of antiplatelet agent in reducing stroke risk in patient who have had TIA. Aspirin is the standard medical therapy for TIA and ischemic stroke therapy. Warfarin is indicated for patients at risk for cardiac embolism. 52. Trigeminal neuralgia Definition : Pain disorder affecting the sensory branches of the trigeminal nerve (5th CN). AKA “tic douloureux” for painful spasm. Women affected more than men (3:2), and it affects older adults more than younger adults. Most cases occur between 50 and 70 years of age with mean age onset of 54 years. Unusual for individuals younger than 40 to be affected. The 5th CN contains motor and sensory nerves that originates in the brainstem. The sensory nerves conduct impulses from the face, head, cornea, conjunctiva, nose, and mouth and terminated in the thalamus. Motor portion of the nerve supplies the muscles of the jaw and sphenoid areas. Two types of trigeminal neuralgia: Primary – Thought to be caused by vascular compression and considered “classic trigeminal neuralgia” Secondary – Differentiated by the ability to demonstrate a structural cause such as trauma, compression, or multiple sclerosis. The location of one of the cerebral arteries and its branches is thought to be a factor by creating compression on the nerve as it exits the brainstem. Presenting Symptoms : Primary feature of this disorder is recurrent paroxysms of pain in the distribution of any branch of the trigeminal nerve. Pain described as burning, stabbing, sharp, penetrating, or electric shock-like and usually unilateral. Suspicion for MS should be raised if the pain is bilateral. The duration of each paroxysm varies from seconds to more than 15 minutes. Pain may recur once a month or several times per day. During an attack, the patient may cease talking, stop chewing, become still, rub or pinch the face, avoid making facial expressions during conversation, grimace, or make movements of the face and jaw. Between attacks the patient is free of symptoms except for fear of an impending attack. 3 Differential Diagnoses : Headache (migraine), acoustic neuroma, trigeminal neuroma, meningioma, aneurysms, acute polyneuropathy, chronic meningitis, other neuralgias, and dental abnormalities. Trigeminal neuralgia is a common cause of pain in multiple sclerosis. Pattern Recognition : A characteristic feature is the trigger zone which is a small area of the skin or orobuccal mucosa that the patient can identify as the point that sets off an attack. Chewing, talking, facial movement, touch, drafts, or cool breezes may elicit paroxysm. The patient may be reluctant for the provider to examine their face for fear of triggering an attack. All CNs must be evaluated in detail and in secondary trigeminal neuralgia the corneal reflex may be abnormal. Diagnosis based primarily on the patient history and physical findings and requires no initial diagnostic laboratory or imaging studies unless history and physical findings suggest secondary trigeminal neuralgia.
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