Clinical History

When interviewing a patient with complaints referable to the trigeminal system there are several key considerations to address. First is the nature of the patient's complaint (that is, pain, sensory changes, sensory loss, or motor difficulty) because the characteristic clinical features are critical components of an appropriate neurological diagnosis. For example, lancinating excruciating pain suggests trigeminal neuralgia and is distinguished from the more tolerable yet disturbing paresthesias of trigeminal sensory neuropathy. Determination of whether the symptoms are intermittent, paroxysmal, or chronic and the temporal profile of symptom development (i.e., whether symptoms began in an acute, subacute, or indolent fashion) also provides diagnostic clues. Thus, sudden complaints of sensory loss, paresthesias, or motor dysfunction in the face are consistent with vascular, traumatic, or demyelinating processes, whereas similar complaints developing over weeks more often reflect neoplastic or inflammatory etiologies. Inquiries regarding a family history of neurological disorders that may run in families and have a possible genetic link, such as multiple sclerosis, stroke, brain tumor, or aneurysm, should be sought. Possible precipitating elements such as recent trauma, toxic exposures, illicit drug abuse, and all medication usage should be identified. It is also important to elicit other neurological symptoms such as autonomic, visual, ocular or facial motor dysfunction, which may help to localize the lesion. Specifically, patients should be questioned regarding changes in facial sweating; recurrent corneal irritation or abrasions; and difficulty blinking, swallowing, or speaking. Specific trigger points of facial pain

psuggest trigeminal neuralgia, and associated oropharyngeal or jaw pain may imply temporomandibular joint disease. It is imperative to identify past or concurrent medical or neurological disorders that may be related etiologically to a patient's complaints of trigeminal dysfunction. Specifically, a history of collagen vascular diseases; prior strokes, diabetes, neoplasms, granulomatous diseases, bleeding disorders; or recent and recurrent infections may prove helpful.

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Supplements For Diabetics

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