Malcolm had pain in the distribution of the trigeminal nerve (usually in the cheek or lower jaw) that was
Severe — described to the GP as electric shock-like, sharp or shooting.
Unilateral — trigeminal neuralgia is bilateral in only 3% of people.
Recurrent — he was experiencing many attacks a day, with a refractory period between each attack.
Provoked by factors such as light touch to the face, eating, talking or exposure to cold air.
These are typical of trigeminal neuralgia – hence why he was managed with Carbemazepine.
Remember, there are other conditions that can lead to compression of the nerve however, such as;
– Multiple sclerosis
– Epidermoid, Dermoid cysts
Think of how you would rule out the above differential diagnoses for Malcolm
Also, assess for the presence of red flag symptoms and signs that may suggest he has RED FLAGS, including:
(if he had trigeminal neuralgia and was under 40 years old, this could also be considered as a red flag.)
If there are symptoms that may suggest a serious underlying cause, admit or refer urgently for specialist assessment, depending on clinical judgement.
If there are no red flag symptoms and signs, offer the person carbamazepine. (NICE 2022)
However Malcolm has now developed a rash!!!!