Walsh & Hoyt: Topical Diagnosis of Disturbances of the Trigeminal Nerve and Its Central Connections

Topical diagnosis in the trigeminal somatic sensory system is based on analysis of the pattern and character of various sensory and motor abnormalities. These abnormalities include objective signs (loss or alteration of sensation, muscle weakness, or hyperactivity, as well as changes in trigeminal reflexes) and subjective symptoms (facial pain, neuralgia, headache, and facial paresthesias). The objective trigeminal signs of sensory loss in the face, weakness of jaw muscles, or both, are dependable indicators of the location of the neurologic lesion. On the other hand, topical diagnosis of isolated subjective symptoms of facial pain, neuralgia, or paresthesia is less precise. In either case, an associated neurologic sign (oculomotor nerve palsy, Horners syndrome, or a brainstem sign) may provide an important clue to the location and nature of the sensory loss or pain.