Which physical findings are characteristic of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Physical examination will usually eliminate alternative diagnoses. However, remember that patients report pain following stimulation of a trigger point; thus, some patients may limit their examination for fear of stimulating these points. For example, male patients may present with an area of the face, the trigger zone, that is unshaven and unkempt.

The diagnosis of idiopathic trigeminal neuralgia (TN) is tenable only if no physical findings of fifth nerve dysfunction or are present. Neurologic examination findings are normal, and facial sensation, masseter bulk and strength, and corneal reflexes should be intact. Thus, no sensory loss is found unless checked immediately after a burst of pain; any permanent area of numbness excludes the diagnosis. Loss of the corneal reflex also excludes the diagnosis of idiopathic trigeminal neuralgia, unless a previous trigeminal nerve section procedure has been performed. Any jaw or facial weakness or swallowing difficulties suggests another etiology.

In patients with multiple sclerosis (MS) or a structural lesion and trigeminal neuralgia, sensory loss often is found on examination.

Although hypesthesia or dysesthesia in the face may be observed transitorily in classic trigeminal neuralgia, these symptoms should be considered part of the symptomatic forms. Paramount, however, is that the absence of these findings does not preclude the presence of an underlying cause; that is, it does not exclude a symptomatic form of trigeminal neuralgia.

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