13.1.1.3 Idiopathic trigeminal neuralgia

Identification: Male patient, 65 years old, with episodes of facial pain for 8 months. History of Present Illness: Pain: Location: Right V2 (maxillary) and V3 (mandibular) Characteristic: Paroxysms of "electric shock" (1-60 seconds) Intensity 10/10 (numeric scale) Frequency: 20-100 episodes/day, clustered in bouts Specific triggers: Chewing (especially solid foods) Touching the upper lip (5mm² trigger area) Cold air Interictal periods: Completely asymptomatic Normal neurological examination Physical/Neurological Examination: Trigeminal assessment: Corneal reflex preserved bilaterally Normal tactile, thermal, and pain sensitivity Symmetrical masticatory muscle strength Provocative tests: Light touch on the upper lip → reproduction of the painful episode General examination: No signs of focal neurological deficits Absence of craniofacial bruits Complementary Examinations: 3T Magnetic Resonance Imaging (FIESTA/CISS sequences): No neurovascular conflict No demyelinating or expansive lesions Cranial Computed Tomography: No bone or compressive anomalies Diagnostic exclusion: Negative serologies for syphilis/Lyme Normal glucose and lipid profile