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2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 3-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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http://youtube.com/watch?v=b2oegRiaA_0 Check out this YouTube Website Living Brightly.
http://www.PartyTentCity.com the best modular party tent, canopy and awning on the market including tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. My websites include
http://www.BrianNelsonConsulting.com For advice on finding business errors and new ideas
http://www.IamFightingCancer.com For my long detailed pain journal story on trigeminal neuralgia facial pain, TNA, TN, parotid gland and multisided lung cancer ,
http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn what your business can do better in making a profit. . http://www.NewMedicalDirectories.com for dozens of medical information sites. http://www.WorldTravelDirectories.com for international travel.
http://www.ChangingIdeas.com for changes needed in the world.
http://www.TheBestHoustonRestaurants.com for great restaurants in Houston, TX.
http://www.NewMedicalDirectories.com/Dogs-Detecting-Cancer/Fact-Or-Fiction.html
http://www.InternationalEducationalDirectories.com/Computer-Learning/Keyboard-Tips-And-Tricks.html
http://www.PooLleakDetectionExperts.com/ Tips on Fixing your swimming pool
http://www.PercussionTeacher.com/ Percussion and Piano Lessons Houston
http://www.IdeaPhotos.com/Video-Clips-Slide-Shows/Funny-Movies.html Funny, Entertaining Humor
http://www.IdeaPhotos.com/George-Bush/Photos-And-Quotes.html George Bush Political Humor
http://www.NelsonIdeas.com/food-information/asparagus-causes-stinky-urine.html Asparagus Causes Stinky Urine
http://youtube.com/profile?user=BrianNelson123
http://www.ChangingIdeas.com/MichaelMoore/Sicko.htmlvideos on YouTube Videos, user BrianNelson123
http://www.MarketingJesusChrist.com Your mission from, if you agree to accept it, is to help other find God.
http://www.GodIsThe.com Great Bible quotes and ideas from mans life guidelines owners manual written by God.
http://www.IdeaPhotos.com/Bridge-Construction/History-Of-Bridges.html History of Bridges. Compendium on the Minneapolis Bridge Collapse on Hwy 35
http://www.HealthAndFitness.com/Mold/CausesAndTreatment.html Dogs Detecting The Location of Mold.
Make a difference in the world. Speak on topics on how we live. Humans have created giant problems for humans. We can correct those errors only if identify them and speak out. Let me videotape you or just your picture and record your voice over the phone to make your ideas known in the world to be viewed on http://www.YouTube.com
What legacy are you going to leave behind? Will the granite stone above your deceased body just state your name. Did you do what God wants you to do to help others? Speak out now and make your views heard. My websites are in the following categories. Animals Anti-Aging Automotive Cancer Computers Consulting Consumer Issues Directories Engineering Entertainment Funny Stuff. Free Internet Space Free Newsletters Foreign Language Sites General Sales Holidays Household Legal Medical Information TN TNA Military Money Finance People to Know Photography Public Issues Real Estate Recreation Religious Technology Tents Tarps Party Tent Canopies Awnings Dome Tents Tent Discounts Travel Trigeminal Neuralgia Extreme Facial Pain Wanted Houston.
No matter what you do please listen to the knowledge of others. My point is that in the NIV of Proverbs 12: 1 "Whoever loves discipline loves knowledge, but he who hates corrections is stupid." I see so many businesses, government agencies, churches, educational institutions, etc. who just really ask questions so they can improve their situations. They trod on wondering when things will ever get better. We all can do better. Let's work together. Make a difference in the world. Share your knowledge. Let me publish your thoughts here. You will be helping you improve in the areas below. It may make someone feel better. Someone else may be able to help you improve your operation. If you need to learn more on how to use your skill to accomplish this let me know. Brian Nelson 713-467-3025. 1ebutuoy 07102007
Check out http://www.PartyTentCity.com We sell new Discount Canopy, Party Tents, Awnings, Camping Tents, & Church Revival tents. For sale are bargain Patio Awning, Portable Garages, Economical Temporary Storage Shelters, Party Canopies and Tents to Rental Companies. We also sell White, Silver Tarpaulins, Mesh Cloth, Shade Cloth, Canopy Kits, Storage Tent, Portable Chuppah, Dome Tents and Awnings. Our canopy kits prices include standard heavy duty rectangular tarps. The steel connects with locking bolts at each port are made for 1" EMT Electrical conduit pipe. We not longer use 3/4 weaker pipe. Fire retardant and Flame Retardant Tarpaulins are available at a premium in limited sizes.
We sell a modular quality tent kit at a fair price. 10x10 can be expanded to a 40x60 with nothing wasted except the tarp. We have hundreds of sizes like 6x8, 10x10, 10x20, 20x20, 20x30, 20x40, 30x30, 30x40, 40x40, 40x50, 40x60 & 50x50.
Flat and Gable Low Peak Connector Fittings for gable roofs are $8 each. ($ 10 if less than 10 are ordered. ) High Peak Roof Connectors are $10. Circus Connectors for Pyramid and Hip roofs are $12. Foot Pads are $ 6 each Ball Bungees are $20/100 White and Silver Tarps are $.12/sq. ft. Fire Retardant Tarps $.24sq. ft.Tent questions? Call me now. Brian Nelson 713-467-3025 M-Sat. 7am-9pm CS SR= Super Reinforced= Strong Upper Triangle. No pole under peak on 20ft clear span models
SD= Super Duper Reinforced= Strong Triangle w/poles every 10 ft.
SRV= Super Reinforced w/ valance using upper side fittings on each outside side pole.
SDV= Super Duper Reinforced w/valance upper side fitting on each outside side pole.
SRV7= Super Reinforced 7'of side tarps on 4 sides and 2 valances.
SDV7= SuperDuper Reinforced 7'side tarps on 4 sides and 2 valances on 4 sides using a 20 ft span. See our tents at http://www.PartyTentCity.com/diagrams40ftwide/60ftlong.html 796 WC to here. (Less)
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58, 04:57, 2008-04-21 16:58:54 Description: CLICK MORE http://www.MarketingJesusChrist.com James Jim Work MDPC Jesus Christ My Lord.Click Bible Pronunciation .com WC 1073 AUDIO Version Pronounce A-M, (More) CLICK MORE http://www.MarketingJesusChrist.com James Jim Work MDPC Jesus Christ My Lord.Click Bible Pronunciation .com WC 1073 AUDIO Version Pronounce A-M, http://www.BrianNelsonConsulting.com/bible/pronunciation.html Click Bible Pronunciation .com AUDIO Version Pronounce N-Z, http://www.BrianNelsonConsulting.com/bible/pronunciation2.html Click Bible Pronunciation WRITTEN Version A-M http://www.briannelsonconsulting.com/bible/pronunciation-words-written.html Click Bible Pronunciation WRITTEN Version N-Z http://www.briannelsonconsulting.com/bible/pronunciation-words-written2.html Click OLD Testament Brian's Bible Audio Visual Reference Directory. View Bible Images. Listen to Bible while you Surf. http://bibledirectories.com/Bible-Audio-Pictures/Old-Testament.html Click NEW Testament Brian's Bible Audio Visual Reference Directory. View Bible Images. Listen to Bible while you Surf. http://bibledirectories.com/Bible-Audio-Pictures/New-Testament.html Click Intelligent Design Creationism-Evolution What is it? http://www.BibleDirectories.com/Intelligent-Design-Creationism-Evolution/What-is-it.html Click Study of Proverbs http://www.BibleDirectories.com/Study-Of-Proverbs/Bible-Covenant.html Click MDPC Future http://www.ChangingIdeas.com/MDPC/Future.html Click History of Easter http://www.BibleDirectories.com/History-of-Easter/Family-Holiday-Celebration.html Click God Is The .com Best Answer to Any Problem. Your Best Friend. One Liner Bible Quotes http://www.GodIsThe.com Click Televangelists-General http://www.BibleDirectories.com/Televangelists-Televangelism/Good-Bad-Ugly.html Click Televangelists-1-of 5-A-B-C. http://www.bibledirectories.com/Televangelists-Televangelism/1-Good-Bad-Ugly.html Click-Televangelists-2-of-5 D-E-F-G-H http://www.bibledirectories.com/Televangelists-Televangelism/2-Good-Bad-Ugly.html ClickTelevangelists 3-of-5 I-J-K-L-M http://www.bibledirectories.com/Televangelists-Televangelism/3-Good-Bad-Ugly.html Click-Televangelists-4-of-5-N-O-P-R http://www.bibledirectories.com/Televangelists-Televangelism/4-Good-Bad-Ugly.html Click Televangelists-5-of-5-S-T-V-W-Z http://www.bibledirectories.com/Televangelists-Televangelism/1-Good-Bad-Ugly.html Click God is The 2 http://www.briannelsonconsulting.com/godisthe.com/index.html Click Memorial Drive Presbyterian Church MDPC http://www.BibleDirectories.com/Memorial-Drive-Presbyterian-Church/MDPC-Houston.html Click Romans 1-16 Commentaries http://www.BibleDirectories.com/Romans/Chapters-1-16-Commentaries.html Click Marketing Jesus Christ http://www.MarketingJesusChrist.com Click Jack And Virginia Lien 60th Wedding And Ordination Anniversary. http://www.BibleDirectories.com/JackLien/60thAnniversary.html 07102007 603 WC 1005 wcmax Hi, I have 321 Informative websites. Some are hyperlinked below. Click on anything blue Click on E-mail me to send me a message from my websites. http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Learn hundreds of tips about YouTube Save it in your favorites. http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html For a printer friendly Version Click : http://www.NelsonsNewsLetter.com Get my free news letter so when I add new websites and YouTube videos of http://www.NelsonIdeas.com interesting, informative, and humor websites Find everything I have at Call me at 713-467-3025 I will help you make a difference in the world. Your word can be heard. Speak up. Speak out. Be heard. Be more of what God made you to be. http://youtube.com/watch?v=b2oegRiaA_0 Check out this YouTube Website Living Brightly. http://www.PartyTentCity.com the best modular party tent, canopy and awning on the market including tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. My websites include http://www.BrianNelsonConsulting.com For advice on finding business errors and new ideas http://www.IamFightingCancer.com For my long detailed pain journal story on trigeminal neuralgia facial pain, TNA, TN, parotid gland and multisided lung cancer , http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn what your business can do better in making a profit. . http://www.NewMedicalDirectories.com for dozens of medical information sites. http://www.WorldTravelDirectories.com for international travel. http://www.ChangingIdeas.com for changes needed in the world. http://www.TheBestHoustonRestaurants.com for great restaurants in Houston, TX. http://www.NewMedicalDirectories.com/Dogs-Detecting-Cancer/Fact-Or-Fiction.html http://www.InternationalEducationalDirectories.com/Computer-Learning/Keyboard-Tips-And-Tricks.html http://www.PooLleakDetectionExperts.com/ Tips on Fixing your swimming pool http://www.PercussionTeacher.com/ Percussion and Piano Lessons Houston http://www.IdeaPhotos.com/Video-Clips-Slide-Shows/Funny-Movies.html Funny, Entertaining Humor http://www.IdeaPhotos.com/George-Bush/Photos-And-Quotes.html George Bush Political Humor http://www.NelsonIdeas.com/food-information/asparagus-causes-stinky-urine.html Asparagus Causes Stinky Urine http://youtube.com/profile?user=BrianNelson123 http://www.ChangingIdeas.com/MichaelMoore/Sicko.htmlvideos on YouTube Videos, user BrianNelson123 http://www.MarketingJesusChrist.com Your mission from, if you agree to accept it, is to help other find God. http://www.GodIsThe.com Great Bible quotes and ideas from mans life guidelines owners manual written by God. Make a difference in the world. Speak on topics on how we live. Humans have created giant problems for humans. We can correct those errors only if identify them and speak out. Let me videotape you or just your picture and record your voice over the phone to make your ideas known in the world to be viewed on http://www.YouTube.com What legacy are you going to leave behind? Will the granite stone above your deceased body just state your name. Did you do what God wants you to do to help others? Speak out now and make your views heard. My websites are in the following categories. Animals Anti-Aging Automotive Cancer Computers Consulting Consumer Issues Directories Engineering Entertainment Funny Stuff. Free Internet Space Free Newsletters Foreign Language Sites General Sales Holidays Household Legal Medical Information TN TNA Military Money Finance People to Know Photography Public Issues Real Estate Recreation Religious Technology Tents Tarps Party Tent Canopies Awnings Dome Tents Tent Discounts Travel Trigeminal Neuralgia Extreme Facial Pain Wanted Houston. No matter what you do please listen to the knowledge of others. My point is that in the NIV of Proverbs 12: 1 "Whoever loves discipline loves knowledge, but he who hates corrections is stupid." I see so many businesses, government agencies, churches, educational institutions, etc. who just really ask questions so they can improve their situations. They trod on wondering when things will ever get better. We all can do better. Let's work together. Make a difference in the world. Share your knowledge. Let me publish your thoughts here. You will be helping you improve in the areas below. It may make someone feel better. Someone else may be able to help you improve your operation. If you need to learn more on how to use your skill to accomplish this let me know. Brian Nelson 713-467-3025. 1ebutuoy 07102007 Check out http://www.PartyTentCity.com We sell new Discount Canopy, Party Tents, Awnings, Camping Tents, & Church Revival tents. For sale are bargain Patio Awning, Portable Garages, Economical Temporary Storage Shelters, Party Canopies and Tents to Rental Companies. We also sell White, Silver Tarpaulins, Mesh Cloth, Shade Cloth, Canopy Kits, Storage Tent, Portable Chuppah, Dome Tents and Awnings. Our canopy kits prices include standard heavy duty rectangular tarps. The steel connects with locking bolts at each port are made for 1" EMT Electrical conduit pipe. We not longer use 3/4 weaker pipe. Fire retardant and Flame Retardant Tarpaulins are available at a premium in limited sizes. We sell a modular quality tent kit at a fair price. 10x10 can be expanded to a 40x60 with nothing wasted except the tarp. We have hundreds of sizes like 6x8, 10x10, 10x20, 20x20, 20x30, 20x40, 30x30, 30x40, 40x40, 40x50, 40x60 & 50x50. Flat and Gable Low Peak Connector Fittings for gable roofs are $8 each. ($ 10 if less than 10 are ordered. ) High Peak Roof Connectors are $10. Circus Connectors for Pyramid and Hip roofs are $12. Foot Pads are $ 6 each Ball Bungees are $20/100 White and Silver Tarps are $.12/sq. ft. Fire Retardant Tarps $.24sq. ft.Tent questions? Call me now. Brian Nelson 713-467-3025 M-Sat. 7am-9pm CS SR= Super Reinforced= Strong Upper Triangle. No pole under peak on 20ft clear span models SD= Super Duper Reinforced= Strong Triangle w/poles every 10 ft. SRV= Super Reinforced w/ valance using upper side fittings on each outside side pole. SDV= Super Duper Reinforced w/valance upper side fitting on each outside side pole. SRV7= Super Reinforced 7'of side tarps on 4 sides and 2 valances. SDV7= SuperDuper Reinforced 7'side tarps on 4 sides and 2 valances on 4 sides using a 20 ft span. See our tents at http://www.PartyTentCity.com/diagrams40ftwide/60ftlong.html 796 WC to here. (Less)
Channel: youtubeTags: 77024 Bible BrianNelson123 Christian Church Com Drive God Houston Ideas Love Memorial Nelson NIV Presbyterian Study TX
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49, 00:56, 2008-04-21 16:19:10 Description: 008 CLICK MORE http://www.EndAddictionToOil.com End Addiction to Oil YouTube Tips and Instructions Printer Friendly Version: (More) 008 CLICK MORE http://www.EndAddictionToOil.com End Addiction to Oil YouTube Tips and Instructions Printer Friendly Version: http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html 40 pages Don't fprget tp view my important website www.EndAddictionToOil.com Oil, Global Warming and oil addiction caused by excessive consumption. You can learn more about using YouTube by viewing my user friendly information and tips site by CLICKING BELOW or copying and pasting this address in your browser http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Remember to save it in your favorites for future reference on problems with learning all about YouTube. It is very handy and easy to use when you are new to using YouTube A compendium on a single very large page. Just keep scanning down for hundreds of tips. As a country we should try to increase our research in better batteries for hybrid and electric cars, and in pollution-free cars that run on hydrogen. We also need additional research in cutting-edge methods of producing ethanol, not just from corn but from wood chips, stalks, or switch grass." Addicted to Oil examines a wide variety of developments taking place across the energy spectrum, from hybrid car enthusiasts who are converting their autos into "plug-ins" and getting 300 miles to a gallon of gas, to the current state of the hydrogen fuel cell. Other areas explored include "flex-fuel" vehicles that can run on an assortment of biofuels such as ethanol, which emits virtually no greenhouse gases and can be made from almost any biomass — like sugar cane, corn and even certain types of grass. (For example, in Brazil, 40 percent of all fuel used by drivers is ethanol.) Solar and especially wind power have made great advances in practical technologies that are increasingly being used throughout the world. We'll also look at new "clean and green" coal plants that are being designed to sequesterallcarbondioxideemissions. Consumption You can learn more about using YouTube by viewing my user friendly information and tips site by CLICKING BELOW or copying and pasting this address in your browser http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Remember to save it in your favorites for future reference on problems with learning all about YouTube. It is very handy and easy to use when you are new to using YouTube A compendium on a single very large page. Just keep scanning down for hundreds of tips.BrianNelson123 http://www.ideaphotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html See All My websites and you tubes at www.NelsonIdeas.com http://www.NelsonIdeas.com/pet-diarrhea/dog-cat.html (1)I have over 300 interesting and informative websites. I would love for you to just view a view a few of them.When you get on my websites you can click on the words E-mail me.Learn more about using hundreds of tips and instructions about YouTube at http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Save it in your favorites For a Printer Friendly Version go to: http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html I can put you on my http://www.NelsonsNewsLetter.com mailing list. I am increasing my website totals everyweek along with more videos of interesting, informative, and sometimes humorous thoughts on YouTube.com All of my websites and YouTube Videos can be found on http://www.NelsonIdeas.com Call me at 713-467-3025 to talk about what is on your mind. I will help you develop a plan of action to see that your word is heard. What do you have to lose. Speak up. Speak out. Be heard. Be fruitful. Be more of what God made you to be. Here are some of Websites. http://www.NelsonIdeas.com BrianNelson123 for YouTube http://www.PartyTentCity.com for tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. http://www.BrianNelsonConsulting.com for advice on making more money, http://www.IamFightingCancer.com for my trigeminal neuralgia and 2 bouts with fighting cancer, http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn how your business Can do a lot better. http://www.NewMedicalDirectories.com for medical information compendium sites. http://www.WorldTravelDirectories.com about international travel. http://www.ChangingIdeas.com for things that have to be changed in the world. Hi, I have 339 Informative websites. Some are hyperlinked below. Click on anything blue Click on E-mail me to send me a message from my websites. http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Learn hundreds of tips about YouTube Save it in your favorites. http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html For a printer friendly Version Click : http://www.NelsonsNewsLetter.com Get my free news letter so when I add new websites and YouTube videos of http://www.NelsonIdeas.com interesting, informative, and humor websites Find everything I have at Call me at 713-467-3025 I will help you make a difference in the world. Your word can be heard. Speak up. Speak out. Be heard. Be more of what God made you to be. http://youtube.com/watch?v=b2oegRiaA_0 Check out this YouTube Website Living Brightly. http://www.PartyTentCity.com the best modular party tent, canopy and awning on the market including tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. My websites include http://www.BrianNelsonConsulting.com For advice on finding business errors and new ideas http://www.IamFightingCancer.com For my long detailed pain journal story on trigeminal neuralgia facial pain, TNA, TN, parotid gland and multisided lung cancer , http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn what your business can do better in making a profit. . http://www.NewMedicalDirectories.com for dozens of medical information sites. http://www.WorldTravelDirectories.com for international travel. http://www.ChangingIdeas.com for changes needed in the world. http://www.TheBestHoustonRestaurants.com for great restaurants in Houston, TX. http://www.NewMedicalDirectories.com/Dogs-Detecting-Cancer/Fact-Or-Fiction.html http://www.InternationalEducationalDirectories.com/Computer-Learning/Keyboard-Tips-And-Tricks.html http://www.PooLleakDetectionExperts.com/ Tips on Fixing your swimming pool http://www.PercussionTeacher.com/ Percussion and Piano Lessons Houston http://www.IdeaPhotos.com/Video-Clips-Slide-Shows/Funny-Movies.html Funny, Entertaining Humor http://www.IdeaPhotos.com/George-Bush/Photos-And-Quotes.html George Bush Political Humor http://www.NelsonIdeas.com/food-information/asparagus-causes-stinky-urine.html Asparagus Causes Stinky Urine http://youtube.com/profile?user=BrianNelson123 http://www.ChangingIdeas.com/MichaelMoore/Sicko.htmlvideos on YouTube Videos, user BrianNelson123 http://www.MarketingJesusChrist.com Your mission from, if you agree to accept it, is to help other find God. http://www.GodIsThe.com Great Bible quotes and ideas from mans life guidelines owners manual written by God. http://www.IdeaPhotos.com/Bridge-Construction/History-Of-Bridges.html History of Bridges. Compendium on the Minneapolis Bridge Collapse on Hwy 35 http://www.HealthAndFitness.com/Mold/CausesAndTreatment.html Dogs Detecting The Location of Mold. Make a difference in the world. Speak on topics on how we live. Humans have created giant problems for humans. We can correct those errors only if identify them and speak out. Let me videotape you or just your picture and record your voice over the phone to make your ideas known in the world to be viewed on http://www.YouTube.com What legacy are you going to leave behind? Will the granite stone above your deceased body just state your name. Did you do what God wants you to do to help others? Speak out now and make your views heard. My websites are in the following categories. Animals Anti-Aging Automotive Cancer Computers Consulting Consumer Issues Directories Engineering Entertainment Funny Stuff. Free Internet Space Free Newsletters Foreign Language Sites General Sales Holidays Household Legal Medical Information TN TNA Military Money Finance People to Know Photography Public Issues Real Estate Recreation Religious Technology Tents Tarps Party Tent Canopies Awnings Dome Tents Tent Discounts Travel Trigeminal Neuralgia Extreme Facial Pain Wanted Houston. No matter what you do please listen to the knowledge of others. My point is that in the NIV of Proverbs 12: 1 "Whoever loves discipline loves knowledge, but he who hates corrections is stupid." I see so many businesses, government agencies, churches, educational institutions, etc. who just really ask questions so they can improve their situations. They trod on wondering when things will ever get better. We all can do better. Let's work together. Make a difference in the world. Share your knowledge. Let me publish your thoughts here. You will be helping you improve in the areas below. It may make someone feel better. Someone else may be able to help you improve your operation. If you need to learn more on how to use your skill to accomplish this let me know. Brian Nelson 713-467-3025. 1ebutuoy 07102007 Check out http://www.PartyTentCity.com We sell new Discount Canopy, Party Tents, Awnings, Camping Tents, & Church Revival tents. For sale are bargain Patio Awning, Portable Garages, Economical Temporary Storage Shelters, Party Canopies and Tents to Rental Companies. We also sell White, Silver Tarpaulins, Mesh Cloth, Shade Cloth, Canopy Kits, Storage Tent, Portable Chuppah, Dome Tents and Awnings. Our canopy kits prices include standard heavy duty rectangular tarps. The steel connects with locking bolts at each port are made for 1" EMT Electrical conduit pipe. We not longer use 3/4 weaker pipe. Fire retardant and Flame Retardant Tarpaulins are available at a premium in limited sizes. We sell a modular quality tent kit at a fair price. 10x10 can be expanded to a 40x60 with nothing wasted except the tarp. We have hundreds of sizes like 6x8, 10x10, 10x20, 20x20, 20x30, 20x40, 30x30, 30x40, 40x40, 40x50, 40x60 & 50x50. Flat and Gable Low Peak Connector Fittings for gable roofs are $8 each. ($ 10 if less than 10 are ordered. ) High Peak Roof Connectors are $10. Circus Connectors for Pyramid and Hip roofs are $12. Foot Pads are $ 6 each Ball Bungees are $20/100 White and Silver Tarps are $.12/sq. ft. Fire Retardant Tarps $.24sq. ft.Tent questions? Call me now. Brian Nelson 713-467-3025 M-Sat. 7am-9pm CS SR= Super Reinforced= Strong Upper Triangle. No pole under peak on 20ft clear span models SD= Super Duper Reinforced= Strong Triangle w/poles every 10 ft. SRV= Super Reinforced w/ valance using upper side fittings on each outside side pole. SDV= Super Duper Reinforced w/valance upper side fitting on each outside side pole. SRV7= Super Reinforced 7'of side tarps on 4 sides and 2 valances. SDV7= SuperDuper Reinforced 7'side tarps on 4 sides and 2 valances on 4 sides using a 20 ft span. See our tents at http://www.PartyTentCity.com/diagrams40ftwide/60ftlong.html 796 WC to here. (Less)
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56, 04:56, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 1-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 1-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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48, 04:38, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 5-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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44, 01:33, 2008-04-22 09:40:54 Description: 012 CLICK MORE http://www.PoolLeakDetectionExperts.com 2 This video is about Diatomaceous Earth better known as DE when used as a swimming pool Filter by the Filter Pool Leak Detection Experts (More) 012 CLICK MORE http://www.PoolLeakDetectionExperts.com 2 This video is about Diatomaceous Earth better known as DE when used as a swimming pool Filter by the Filter Pool Leak Detection Experts Houston whose website is http://www.PoolLeakDetectionExperts.com/ Owned and Operated by David Baker 713-805-7049 Important topics found on that website are Swimming Pool & Spa Leak Detection Expert David Bakerwho Can Repair, Pools, Service, Pumps, Motors, Salt Systems, Waterfalls, Concrete Tanks, Fiberglass Structures, Call David Baker at 713-805-7049 for help with your In Ground or Above Ground Pools, Reasonable Prices, Prompt Service, Experienced Experts, Chemical Applications, Water Conservation, Meter Inspectors, Commercial, Residential, Backwashing, Valve Positions,They are Members of the IPSSA Service Association A small leak from your pool can add up to big dollars spent on repairs on both your pool and your home. You can lose money in higher water bills, extra chemicals needed, stress to pool equipment, and underground erosion.Diatomaceous Earth is critical to cleaning your pool. Leak Detections. We perform a full leak detection on your pool to ensure that we find all leaks. We pressure test the lines at 20 P.S.I. and use advanced ultrasound and helium equipment to pin point your problem. Our company offers a full range of services from plaster repair to new equipment installation. We also do conversions to salt systems which saves you time and money. Please contact us with your specific question. We Look forward to exceeding your expectations. Owned and Operated by David Baker 713-805-7049 Our company was established in 1985. We have successfully served the needs of our customers in Houston and surrounding areas for 21 years. We maintain 125 residential pools through Mediterranean Pools as well as a full service repair division. Our goal is to keep the fun in your aquatic recreations and leave the worries to us. We are members of IPSSA Houston Chapter. IPSSA helps you feel comfortable with who is in your backyard by being the Gateway to both pool and spa professionals. Formed in 1988, they represent the best most trained reliable companies available. See the membership directory below. You can learn all about your pool on our website http://www.poolleakdetectionexperts.com/ I have over 300 interesting and informative websites. I would love for you to just view a view a few of them.When you get on my websites you can click on the words E-mail me.Learn more about using hundreds of tips and instructions about YouTube at http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Save it in your favorites For a Printer Friendly Version go to: http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html I can put you on my http://www.NelsonsNewsLetter.com mailing list. I am increasing my website totals everyweek along with more videos of interesting, informative, and sometimes humorous thoughts on YouTube.com All of my websites and YouTube Videos can be found on http://www.NelsonIdeas.com Call me at 713-467-3025 to talk about what is on your mind. I will help you develop a plan of action to see that your word is heard. What do you have to lose. Speak up. Speak out. Be heard. Be fruitful. Be more of what God made you to be. Here are some of Websites. http://www.NelsonIdeas.com BrianNelson123 for YouTube http://www.PartyTentCity.com for tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. http://www.BrianNelsonConsulting.com for advice on making more money, http://www.IamFightingCancer.com for my trigeminal neuralgia and 2 bouts with fighting cancer, http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn how your business Can do a lot better. http://www.NewMedicalDirectories.com for medical information compendium sites. http://www.WorldTravelDirectories.com about international travel. http://www.ChangingIdeas.com for things that have to be changed in the world. (Less)
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42, 05:07, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 4-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 4-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
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41, 01:38, 2008-04-21 21:49:59 Description: 3 of 3 Click Me http://www.NelsonIdeas.com where you can see about all my 342 websites and 87 youtube videos. This is 1-3 videos about Golden Gate Bridge on Brian and Rosemary Nelsons trip to San (More) 3 of 3 Click Me http://www.NelsonIdeas.com where you can see about all my 342 websites and 87 youtube videos. This is 1-3 videos about Golden Gate Bridge on Brian and Rosemary Nelsons trip to San Francisco Dec. 27, 2007 to Jan. 1, 2008 Here are some dtails about this beautiful bridge which gives you an opportunity to view the gorgeous site of the city. GOLDEN GATE BRIDGE. The Golden Gate Bridge is a suspension bridge spanning the Golden Gate from the opening into the San Francisco Bay to the Pacific Ocean. It connects the city of San Francisco on the northern tip of the San Francisco Peninsula to Marin County as part of US Highway 101 and State Route 1. The Golden Gate Bridge had the longest suspension bridge span in the world when it was completed in 1937 and has become an internationally recognized symbol of San Francisco and the United States. In the 70 years since completion, the span length has been surpassed by seven other bridges. It still has the second longest suspension bridge main span in the United States, after the Verrazano-Narrows Bridge in New York City. DATA Carries6 lanes of U.S. Route 101/State Route 1, pedestrians and bicycles CrossesGolden Gate LocaleSan Francisco, California and Marin County, California Maintained byGolden Gate Bridge, Highway and Transportation District [2] DesignSuspension, truss arch & truss causeways Longest span4,200 feet (1,280 m)[1] Total length8,981 feet (2,737 m) Width90 feet (27 m) Height746 feet (227 m) Vertical clearance14 feet (4.3 m) at toll gates, higher truck loads possible Clearance below220 feet (67 m) at mean higher high water AADT100,000[1] Opening dateMay 27, 1937 SETTING The Golden Gate Bridge spans the Golden Gate, a narrow, 400-foot (120 m) deep strait that serves as the mouth of the San Francisco Bay, between San Francisco at the northernmost tip of the San Francisco Peninsula, and the Marin Headlands at the far southern end of Marin County. Although close by proximity, the two sides of the strait are separated by significant natural obstacles. Crossing the strait directly by boat is treacherous due to strong currents and lack of suitable landings. Ocean tides drive an average of 528 billion gallons (2 billion cubic meters) of water every six hours, at peak currents exceeding 5.6 miles per hour (2.5 m/s). Circumnavigating the Bay, however, involves a trip of several hundred miles and crossing several major rivers. FERRY SERVICE Before the bridge was built, the only practical short route from San Francisco to what is now Marin County was by boat, through the interior of the San Francisco Bay. Ferry service began as early as 1820, with regularly scheduled service beginning in the 1840s for purposes of transporting water to San Francisco from what is now Marin County.[3] The Sausalito Land and Ferry Company service launched in 1868, which eventually became the Golden Gate Ferry Company, a Southern Pacific Railroad subsidiary, the largest ferry operation in the world by the late 1920s.[3][4]Once for railroad passengers and customers only, Southern Pacific's automobile ferries became very profitable and important to the regional economy.[5] The ferry crossing between the Hyde Street Pier at the foot of Van Ness Avenue in San Francisco and Sausalito in Marin County took approximately 20 minutes and cost $1.00 per vehicle, a price later reduced to compete with the new bridge. The trip from the Ferry Building took twenty-seven minutes. Many wanted to build a bridge to connect San Francisco to Marin County. San Francisco was the largest American city still served primarily by ferry boats. Because it did not have a permanent link with communities around the bay, the city's growth rate was below the national average. Many experts said a bridge couldn't be built across the 6,700-ft.-wide (2,042 m) strait. It had strong, swirling tides and currents, with water 335 ft (102 m) deep at the center of the channel, and almost constant winds of 60 mph (97 km/h). Experts said ferocious winds and blinding fogs would prevent construction and operation. WC604 CONCEPTION (Less)
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45, 00:41, 2007-09-12 19:58:19 Description: Click More http://www.Stupid123.com http://www.Stupid123.com/StoreSignSpellings/SonicDriveInSmooty.html Sonic Drive In Fat Free Peach Smooty is one of the new things on the menu. I wonder how (More) Click More http://www.Stupid123.com http://www.Stupid123.com/StoreSignSpellings/SonicDriveInSmooty.html Sonic Drive In Fat Free Peach Smooty is one of the new things on the menu. I wonder how different a smooty is from a Smoothy or a real life Maybe it gives a big smoot with each smooty Or maybe the color of it is black because it is sooty or souty. I guess you are supposed to eat the Smooty or Smoothie or what ever it is supposed to be even if you spelled it wrong. I looked up smooty on the net and found it to be a skinny girl. IT said a smooty was a Smooty is made of felt and has an appliqued wing and embroidered little face. He's two inches across with a silver pin on the back.
This video is not about the Spelling of Peaches Funny Misspellings of smoothies or a smoothie king where there is a Sign Fast Food. This Sonic Employee manages the wordings for signs in Houston Sign Spell each word as if it was a very important part of our vocabulary. This lesson took place on Dairy Ashford in Houston between Memorial Drive and I-10 on Dairy Ashford. . BrianNelson123 Intelligence Funny Fast Food. Employee Smoothy Smoothie Spelling Peaches
History
Troy Smith opened the first Sonic Drive-In in Shawnee, Oklahoma, in 1953, calling it the Top Hat.[2] The Top Hat was originally a small root beer stand. Customers would park anywhere on the gravel lot. On a trip to Louisiana, Smith saw a drive-in that utilized speakers for ordering and realized that he could increase his sales if he could control the parking and have the customers order from speakers at their cars with carhops to deliver the food. He borrowed several cars from a friend who owned a used car lot to establish a layout for controlled parking. He had some "juke box boys" come in to wire up an intercom system. His sales tripled immediately and his little root beer stand was a huge success. Grocery store operator Charles Pappe stopped by chance at the Shawnee drive-in and was very impressed. He got out of his car and began to take measurements of the stalls, trying to figure out why they were not all the same size, assuming that it was an essential ingredient of the business plan. Smith came out and introduced himself and explained that the stalls were different sizes simply because different-sized cars had been used when he laid everything out. The two men hit it off and negotiated the first franchise location in Woodward, Oklahoma, in 1956.
By 1958, two more drive-ins were built in Enid, OK, and Stillwater, OK. Troy Smith and Charlie Pappe then learned that the Top Hat name was already trademarked, so they changed the name to Sonic from their slogan "Service with the Speed of Sound". After the name change, the first Sonic sign was installed at the former Top-Hat Drive-In in Stillwater, Oklahoma, therefore that location can be considered the first Sonic Drive-In. That original sign can still be seen in Stillwater. Troy and Charlie were being asked to help open new franchise locations but they had no royalty plan. Finally they decided to have their paper company charge an extra penny for each Sonic label hamburger bag they sold, half for Troy and half for Charlie and the first franchise contracts under this plan were drawn up by Troy's landlord, lawyer O.K. Winterringer. There was no joint marketing plan or standardized menu and few operating requirements.
Sonic grew into a regional phenomenon in the 1960s and 1970s. Located mainly in small towns in Oklahoma, Texas, Kansas, New Mexico, Missouri and Arkansas, the Sonic Drive-in was often the most popular gathering place for young people in those small towns. The exterior of a fairly typical Sonic from this period (the one located in Marfa, Texas) can be seen briefly in the 1985 Kevin Costner film Fandango (1985 film). In the 1960s, Sonic meals were always accompanied by a peppermint candy and small colored plastic animals called zoo-picks hanging on the side of drink cups. In small, southwest U.S. towns it was common to see these Sonic zoo-pick collections on customers' dashboards and rear-view mirrors until they were outlawed by consumer product safety laws as a choking hazard. The traditional peppermint candy is still served with Sonic meals today. n
Sonic's founders formed Sonic Supply in the 1960s under Troy Smith, Marvin Jirous and Matt Kinslow. In 1973, this became Sonic Industries which sold franchisees the equipment and building plans and provided some basic operational instruction. For a brief time in 1977, there was a Sonic school under Jim Winterringer. Most of the drive-ins were operated by franchisees who often made the manager a partner, and that is still often the case today. Since there were at that time no strict procedures and few recipes in place, franchisees or franchise groups often developed their own recipes for different menu items or regional specialties.One group would use "krinkle" cut french fries, others would use shoestring fries. Test (Less)
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38, 02:12, 2008-04-22 09:04:04 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 6-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 6-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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40, 05:03, 2008-04-22 09:04:03 Description: Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 (More) Click More http://www.MyTrigeminalNeuralgiaStory.com AWC 4398 2-6 Microvascular Decompression MVD Click Dr.Parrish Neurosurgeon TN Tic douloureux Facial Pain Electric Shocks. TNA BrianNelson123 Suicide Painful Jannetta Association Teflon Nerve THIS WEBSITE IS DESIGNED TO HAVE EACH TRIGEMINAL NEURALGIA patient tell there story from the beginning of the problem to the current status which is understandably changing daily as the body processes more of the pain. My personal story is very long and and be seen at w htttp[://www.IamFightingCancer.com Important words found on this site. Trigeminal Neuralgia Minneapolis TN Pain Personal Story, Balloon Compression Mentor, dysesthesia, bad feeling constant spasm. excruciating pains, Henry, Pneumonia Electrical Shocks, Shirley, Shelly Wilson, Support Group, Education, Association, Stabbing, Jolts, Suicide Disease, Neuropathic, rare Disorder, Treatment, destructive surgery, Procedure, Microvascular Decompression, tic douloureux Marge Prietz Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. YouTube. From NelsonIdeas.com Trigeminal Neuralgia Extreme Facial Pain TN Websites insert. Websites insert. My Trigeminal Neuralgia Extreme Facial Pain TN Websites http:/./www.NelsonIdeas.com Click Dental Education Trigeminal Neuralgia Extreme Facial Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Dental/Dentist-Dentists.html Click Trigeminal Neuralgia Patient Painful-Stories http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html Click My Trigeminal Neuralgia (TN) Story only http://www.PartyTentCity.com/mytnstory.html Click My Story on TN Brian N http://www.PartyTentCity.com/trigeminal-neuralgia-tn-tmj-my-story/directory.html Click Trigeminal Neuralgia Slide Show Story of Pain http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Medical Data Base Medical Costs More Expensive Due to Non Use of Technology http://www.briannelsonconsulting.com/medical-data-base/faq-info.html Click MyTrigeminal Neuralgia Story Directory http://www.MyTrigeminalNeuralgiaStory.com Click Slide Show Draft for New TN Patients. http://www.newmedicaldirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click-Trigeminal Neuralgia Assn Page 1 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain.html Click-Trigeminal Neuralgia Assn Page 2 http://newmedicaldirectories.com/Trigeminal-Neuralgia-Association/TN-Facial-Pain-2.html Click What is Trigeminal Neuragia? Portland,OR Slide Show http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia National Conference http://www.NewMedicalDirectories.com/Trigeminal-Neuralgia-Slide-Show/Draft.html Click Trigeminal Neuralgia Brian's Journal Tic Douloureux (TN) FacialPain-Cancer http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 1. Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info.html Click Page 2 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info2.html Click Page 3 Trigeminal Neuralgia http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/faq-info3.htm Click Page 4 Trigeminal Neuralgia http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/faq-info4.html Click MyTrigeminal Neuralgia Stories Directory http://www.MyTrigeminalNeuralgiaStory.com/Index.html Click Brian's TN Story Quck Version http://www.MyTrigeminalNeuralgiaStory.com/BrianNelson/TN1.html Click Shirley's Story Trigeminal Neuralgia http://www.MyTrigeminalNeuralgiaStory.com/ShirleyH/TN3.html Click Sand's Story TN WHAT IS TRIGEMINAL NEURALGIA? TN (Trigeminal Neuralgia) is a pain that is described as among the most acute known to mankind. TN produces excruciating, lightning strikes of facial pain, typically near the nose, lips, eyes or ears. It is a disorder of the trigeminal nerve, which is the fifth and largest cranial nerve. TN (Trigeminal Neuralgia / tic douloureux) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the branches of the nerve are distributed - lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. By many, it's called the "suicide disease". A less common form of the disorder called "Atypical Trigeminal Neuralgia" may cause less intense, constant, dull burning or aching pain, sometimes with occasional electric shock-like stabs. Both forms of the disorder most often affect one side of the face, but some patients experience pain at different times on both sides. Onset of symptoms occurs most often after age 50, but cases are known in children and even infants. Something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze can trigger an attack, resulting in sheer agony for the individual. Trigeminal neuralgia (TN) is not fatal, but it is universally considered to be the most painful affliction known to medical practice. Initial treatment of TN is usually by means of anti-convulsant drugs, such as Tegretol or Neurontin. Some anti-depressant drugs also have significant pain relieving effects. Should medication be ineffective or if it produces undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. http://www.MyTrigeminalNeuralgiaStory.com/SandiW/TN4.html What is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening. The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves. Is there any treatment? Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, and complementary approaches. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves. What is the prognosis? The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal. What research is being done? Within the NINDS research programs, trigeminal neuralgia is addressed primarily through studies associated with pain research. NINDS vigorously pursues a research program seeking new treatments for pain and nerve damage with the ultimate goal of reversing debilitating conditions such as trigeminal neuralgia. NINDS has notified research investigators that it is seeking grant applications both in basic and clinical pain research. An Alternate Strategy Instead of waiting for the pain to become intractable or the medications toxic, an individual with trigeminal neuralgia has the option to request early surgery. This has a number of potential advantages: • Avoid years of medication and intermittent pain • Avoid facing surgery when old or infirm • If the person has a vascular loop, early microvascular decompression will increase the possibility of a successful operation with decreased risk of recurrence (evidence suggests better outcomes and lower recurrence rate the shorter the interval between onset of symptoms and nerve decompression) How To Find Out If You Have a Vascular Loop The conventional MRI scans used to rule out the presence of a brain tumor or multiple sclerosis as a cause of a patients face pain are not adequate to visualize the trigeminal nerve or an associated blood vessel. Fortunately, the continued improvement in MRI neuro-imaging now makes it possible to visualize both. The technique, which is called 3-D volume acquisition, is performed with contrast injection and utilizes thin cuts (0.8mm), without gaps similar to what was developed for MRI angiography and venography. The trigeminal nerve is easily visualized in the axial plane when the MRI series is centered at the midpoint of the fourth ventricle. To ensure an adequate evaluation, the nerve should be seen on three adjacent cuts. Early studies indicate that when an offending vessel is present it will be detected 80% of the of the time. With continued imaging improvements this percentage will definitely increase. Click here for UCSD Trigeminal Neuralgia Sequence Parameters for Seimens and GE MR Scanners. Surgical Options: Non-Destructive Procedures The only non-destructive procedure which reliably relieves the symptoms of Trigeminal Neuralgia is Microvascular Decompression (MVD). This involves surgical exploration with the operating microscope and visualization of the junction where the Trigeminal nerve enters the base of the brain, followed by coagulation or moving and padding away any compressing blood vessels. The advantage is pain relief without numbness in the majority of patients, which usually lasts indefinitely. If the pain recurs after a MVD, which it does in 10-15% of patients, it can usually be controlled with low dose Tegretol® or Neurontin®. If the pain continues, it will require a repeat MVD or one of the destructive procedures. Surgical Options: Destructive Procedures There are multiple destructive procedures which are beneficial in the treatment of Trigeminal Neuralgia. The most common of which are glycerol injections, gamma knife radiation, electrocoagulation, and balloon compression. These procedures are all based on interrupting the pain by partial damage to Trigeminal nerve fibers. Generally the more numbness they produce, the longer they last. The specific advantages and disadvantages need to be discussed with the surgeon performing the procedure. These procedures are recommended for patients who have failed MVD or are not candidates for major surgery. Comments Treatment is always individualized. All of the options above should be considered in consultation with a neurosurgeon familiar in their use. Recommendations Based on the data currently available, and in an effort to maximize quality of life, we recommend the following: Patients with less than 10 year life expectancy Refer for destructive procedure if pain not controlled medically without significant side effects Patients with more than 10 but less than 20 year life expectancy Consider destructive procedure May abolish need for continued increasing medications Will make medical therapy easier even if fails Patients with more than 20 year life expectancy Perform thin cut MRI with 3-D Volume Acquisition If vessel present recommend MVD 25 ARTICLE SECTIONS From the Mayo Clinic. Trigeminal neuralgia http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446 Introduction Signs and symptoms Causes When to seek medical advice Screening and diagnosis Treatment Coping skills Introduction Imagine having a jab of lightning-like pain shoot through your face when you brush your teeth or put on makeup. Sound excruciating? If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also be provoked by even mild stimulation of your face, including brushing your teeth, shaving or putting on makeup. The pain of trigeminal neuralgia may occur in a fairly small area of your face, or it may spread rapidly over a wider area. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia, either with medications or surgery. Signs and symptoms An attack of trigeminal neuralgia can last from a few seconds to about a minute. Some people have mild, occasional twinges of pain, while other people have frequent, severe, electric-shock-like pain. The condition tends to come and go. You may experience attacks of pain off and on all day, or even for days or weeks at a time. Then, you may experience no pain for a prolonged period of time. Remission is less common the longer you have trigeminal neuralgia. People who have experienced severe trigeminal neuralgia have described the pain as: Lightning-like or electric-shock-like Shooting Jabbing Like having live wires in your face Trigeminal neuralgia usually affects just one side of your face. The pain may affect just a portion of one side of your face or spread in a wider pattern. Rarely, trigeminal neuralgia can affect both sides of your face, but not at the same time. Causes Branches of the trigeminal nerve CLICK TO ENLARGE The condition is called trigeminal neuralgia because the painful facial areas are those served by one or more of the three branches of your trigeminal nerve. This large nerve originates deep inside your brain and carries sensation from your face to your brain. The pain of trigeminal neuralgia is due to a disturbance in the function of the trigeminal nerve. Trigeminal neuralgia is also known as tic douloureux. The cause of the pain usually is due to contact between a normal artery or vein and the trigeminal nerve at the base of your brain. This places pressure on the nerve as it enters your brain and causes the nerve to misfire. Physical nerve damage or stress may be the initial trigger for trigeminal neuralgia. After the trigeminal nerve leaves your brain and travels through your skull, it divides into three smaller branches, controlling sensation throughout your face: The first branch controls sensation in your eye, upper eyelid and forehead. The second branch controls sensation in your lower eyelid, cheek, nostril, upper lip and upper gum. The third branch controls sensations in your jaw, lower lip, lower gum and some of the muscles you use for chewing. You may feel pain in the area served by just one branch of the trigeminal nerve, or the pain may affect all branches on one side of your face. Besides compression from blood vessel contact, other less frequent sources of pain to the trigeminal nerve may include: Compression by a tumor Multiple sclerosis A stroke affecting the lower part of your brain, where the trigeminal nerve enters your central nervous system A variety of triggers, many subtle, may set off the pain. These triggers may include: Shaving Stroking your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling Trigeminal neuralgia affects women more often than men. The disorder is more likely to occur in people who are older than 50. About 5 percent of people with trigeminal neuralgia have other family members with the disorder, which suggests a possible genetic cause in some cases. When to seek medical advice Some people mistake the pain of trigeminal neuralgia for a toothache or a headache. It's not uncommon for people to believe that their facial pain is dental-related, particularly when the pain seems to stem from the gumline or is located near a tooth. If you experience facial pain, particularly prolonged pain or pain that hasn't gone away with use of over-the-counter pain relievers, see your dentist or doctor. Screening and diagnosis If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain. If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head. Treatment Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you. Medications Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea. Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness. Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness. Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision. Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin). Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option. Surgery The goal of a number of surgical procedures is to either damage or destroy the part of the trigeminal nerve that's the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve: Alcohol injection. Alcohol injections under the skin of your face, where the branches of the trigeminal nerve leave the bones of your face, may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief isn't permanent, you may need repeated injections or a different procedure. Glycerol injection. This procedure is called percutaneous glycerol rhizotomy (PGR). "Percutaneous" means through the skin. Your doctor inserts a needle through your face and into an opening in the base of your skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion (the area where the trigeminal nerve divides into three branches) and part of its root. Images are made to confirm that the needle is in the proper location. After confirming the location, your doctor injects a small amount of sterile glycerol. After three or four hours, the glycerol damages the trigeminal nerve and blocks pain signals. Initially, PGR relieves pain in most people. However, some people have a recurrence of pain, and many experience facial numbness or tingling. http://www.MyTrigeminalNeuralgiaStory.com Balloon compression. In a procedure called percutaneous balloon compression of the trigeminal nerve (PBCTN), your doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle. The balloon is inflated with enough pressure to damage the nerve and block pain signals. PBCTN successfully controls pain in most people, at least for a while. Most people undergoing PBCTN experience facial numbness of varying degrees, and more than half experience nerve damage resulting in a temporary or permanent weakness of the muscles used to chew. http://www.MyTrigeminalNeuralgiaStory.com Electric current. A procedure called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR) selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull. Once in place, an electrode is threaded through the needle until it rests against the nerve root. An electric current is passed through the tip of the electrode until it's heated to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. PSRTR successfully controls pain in most people. Facial numbness is a common side effect of this type of treatment. The pain may return after a few years. Microvascular decompression (MVD). A procedure called microvascular decompression (MVD) doesn't damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root and separating the nerve root and blood vessels with a small pad. During MVD, your doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and the artery. Doctors usually remove a vein that is found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time, but as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. http://www.MyTrigeminalNeuralgiaStory.com While MVD has a high success rate, it also carries risks. There are small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve. Severing the nerve. A procedure called partial sensory rhizotomy (PSR) involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the nerve. This procedure usually is helpful, but almost always causes facial numbness. And it's possible for pain to recur. If your doctor doesn't find an artery or vein in contact with the trigeminal nerve, he or she won't be able to perform an MVD, and a PSR may be done instead. Radiation. Gamma-knife radiosurgery (GKR) involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain. Relief isn't immediate and can take several weeks to begin. GKR is successful in eliminating pain more than half of the time. Sometimes the pain may recur. The procedure is painless and typically is done without anesthesia. Because this procedure is relatively new, the long-term risks of this type of radiation are not yet known. • Coping skills Living with trigeminal neuralgia can be difficult. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find that talking to a counselor or therapist can help you cope with the effects of trigeminal neuralgia, or you may find encouragement and understanding in a support group. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your doctor may be able to recommend a group in your area. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. Frequency: Internationally: TN is uncommon, with an estimated prevalence of 155 cases per million persons. Mortality/Morbidity: No mortality is associated with idiopathic TN, although secondary depression is common if a chronic pain syndrome evolves. In rare cases, pain may be so frequent that oral nutrition is impaired. In symptomatic or secondary TN, morbidity or mortality relates to the underlying cause of the pain syndrome. Sex: Male-to-female ratio is 2:3. Age: Development of trigeminal neuralgia in a young person suggests the possibility of multiple sclerosis. Idiopathic TN typically occurs in patients in the sixth decade of life, but it may occur at any age. Symptomatic or secondary TN tends to occur in younger patients. 27 Background: Trigeminal neuralgia (TN), also known as tic douloureux, is a pain syndrome recognizable by patient history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Physical examination eliminates alternative diagnoses. Signs of cranial nerve dysfunction or other neurologic abnormality exclude the diagnosis of idiopathic TN and suggest that pain may be secondary to a structural lesion. Pathophysiology: The mechanism of pain production remains controversial. One theory suggests that peripheral injury or disease of the trigeminal nerve increases afferent firing in the nerve; failure of central inhibitory mechanisms may be involved as well. Pain is perceived when nociceptive neurons in a trigeminal nucleus involve thalamic relay neurons. Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons. An abnormal vascular course of the superior cerebellar artery is often cited as the cause. In most cases, no lesion is identified, and the etiology is labeled idiopathic by default. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome. Thus, although TN typically is caused by a dysfunction in the peripheral nervous system (the roots or trigeminal nerve itself), a lesion within the central nervous system may rarely cause similar problems. Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks. http://www.MyTrigeminalNeuralgiaStory.com (Less)
Channel: youtubeTags: Association BrianNelson123 douloureux Electric Facial Jannetta Nerve Pain Painful Shocks. Suicide Teflon Tic TN TNA
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36, 00:43, 2008-02-19 14:51:33 Description: Visit http://www.PartyTentCity.com 8PTCZ 10x20 SD $189 Portable Garage Support 10 x 20
I have many other videos of party tents, Awnings, and Canopies with different sizes, model structures as (More) Visit http://www.PartyTentCity.com 8PTCZ 10x20 SD $189 Portable Garage Support 10 x 20
I have many other videos of party tents, Awnings, and Canopies with different sizes, model structures as follows.
Photo samples are available on http://www.PartyTentCity.com of tents, tarps, awnings, back yard movie screens, domes and canopies.
http://www.PartyTentCity.com is the most flexible modular tent supplier in the USA for large or small tents, awnings, canopies, back yard movie screens, domes, etc. including party tent, party tents, canopy, rental tents, wedding tents, As a tent manufacturer we do not sell used party tents but we do sell tents to rental companies or buyers of large frame tents for rent event and revival tents, Here are our 90 most popular models but we can make other sizes to fit your needs. Our units are canopy tent kits. Just click on the link below. You purchase the 1"EMT electrical conduit pipe 10ft. long from Home Depot. It is too heavy to ship. Call me with any questions. Brian Nelson 713-467-3025. http://www.NelsonIdeas.com
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Channel: youtubeTags: 40x60 713-467-3025 backyard BrianNelson123 Building Camping canopies Discount domes movie New reception screens
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38, 01:17, 2007-04-23 20:17:07 Description: 002 CLICK MORE http://www.IAmFightingCancer.com Brian Nelson Introduces his
website www.IamFightingCancer.com. Brian explains Trigeminal Neuralgia one
of the Most Painful medical disorders on the (More) 002 CLICK MORE http://www.IAmFightingCancer.com Brian Nelson Introduces his
website www.IamFightingCancer.com. Brian explains Trigeminal Neuralgia one
of the Most Painful medical disorders on the planet suffered by 1 in 25,000
people as facial Pain. http://www.MyTrigeminalNeuralgiaStory.com with 5 new videos indluding a brain operation video doing a MVD Microvasulcar Decompression. Also see Dr. Tony Whitworth, Neurosurgeon install a occipital nerve stimulator via a video.You can learn more about using YouTube by viewing my user friendly information and tips site by CLICKING BELOW or copying and pasting this address in your browser http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Remember to save it in your favorites for future reference on problems with learning all about YouTube. It is very handy and easy to use when you are new to using YouTube A compendium on a single very large page. Just keep scanning down for hundreds of tips. After a year it was discovered that the pain was
coming from a cancerous Tumor on the parotid gland in the cheek that
provides saliva so that you can eat and swallow. Brian gets calls and emails
on his journal from patients with similar medical problems. They help each
other. Call Brian at 713-467-3025 or email him bnelson@partytentcity.com.
You can post your medical journal on the web free and you can help each
other identify sources and treatment for your pain. Call me at 713-467-3025. I will post your pain journal on the web at no charge if you email your printed story and pictures. People from around the world may be helped by telling your story about your pain and what you have been going through They alos might hep you when they know something about a similar pain in their life and how they treated it. email me at bnelson@PartyTentCity.com
You can learn more about using YouTube by viewing my user friendly information and tips site by CLICKING BELOW or copying and pasting this address in your browser http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Remember to save it in your favorites for future reference on problems with learning all about YouTube. It is very handy and easy to use when you are new to using YouTube A compendium on a single very large page. Just keep scanning down for hundreds of tips. Brian Nelson 713-467-3025 YouTube Tips and Instructions Printer Friendly Version: http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html 40 pages
(1)I have over 300 interesting and informative websites. I would love for you to just view a few of them. When you get on my websites you can click on the words E-mail me.Learn more about using hundreds of tips and instructions about YouTube at http://www.IdeaPhotos.com/YouTube/Tips-And-Instructions.html Save it in your favorites For a Printer Friendly Version go to: http://www.IdeaPhotos.com/YouTube/Printer-Friendly-Tips-And-Instructions.html I can put you on my http://www.NelsonsNewsLetter.com mailing list. I am increasing my website totals everyweek along with more videos of interesting, informative, and sometimes humorous thoughts on YouTube.com All of my websites and YouTube Videos can be found on http://www.NelsonIdeas.com Call me at 713-467-3025 to talk about what is on your mind. I will help you develop a plan of action to see that your word is heard. What do you have to lose. Speak up. Speak out. Be heard. Be fruitful. Be more of what God made you to be.
Here are some of Websites. http://www.NelsonIdeas.com BrianNelson123 for YouTube http://www.PartyTentCity.com for tarps, tents, shadecloth, meshcloth and fire retardant tarpaulins. http://www.BrianNelsonConsulting.com for advice on making more money, http://www.IamFightingCancer.com for my trigeminal neuralgia and 2 bouts with fighting cancer, http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn how your business Can do a lot better. http://www.NewMedicalDirectories.com for medical information compendium sites. http://www.WorldTravelDirectories.com about international travel. http://www.ChangingIdeas.com for things that have to be changed in the world.
Hi, I have 339 Informative websites. Some are hyperlinked below. Click on anything blue Click on E-mail me to send me a message from my websites.
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Learn hundreds of tips about YouTube Save it in your favorites.
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http://www.NelsonsNewsLetter.com Get my free news letter so when I add new websites and YouTube videos of http://www.NelsonIdeas.com interesting, informative, and humor websites Find everything I have at Call me at 713-467-3025 I will help you make a difference in the world. Your word can be heard. Speak up. Speak out. Be heard. Be more of what God made you to be.
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http://www.BrianNelsonConsulting.com For advice on finding business errors and new ideas
http://www.IamFightingCancer.com For my long detailed pain journal story on trigeminal neuralgia facial pain, TNA, TN, parotid gland and multisided lung cancer ,
http://www.EndAddictionToOIl.com on how we can change the energy problems in the world. http://www.TheBusinessCritic.com to learn what your business can do better in making a profit. . http://www.NewMedicalDirectories.com for dozens of medical information sites. http://www.WorldTravelDirectories.com for international travel.
http://www.ChangingIdeas.com for changes needed in the world.
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Make a difference in the world. Speak on topics on how we live. Humans have created giant problems for humans. We can correct those errors only if identify them and speak out. Let me videotape you or just your picture and record your voice over the phone to make your ideas known in the world to be viewed on http://www.YouTube.com
What legacy are you going to leave behind? Will the granite stone above your deceased body just state your name. Did you do what God wants you to do to help others? Speak out now and make your views heard. My websites are in the following categories. Animals Anti-Aging Automotive Cancer Computers Consulting Consumer Issues Directories Engineering Entertainment Funny Stuff. Free Internet Space Free Newsletters Foreign Language Sites General Sales Holidays Household Legal Medical Information TN TNA Military Money Finance People to Know Photography Public Issues Real Estate Recreation Religious Technology Tents Tarps Party Tent Canopies Awnings Dome Tents Tent Discounts Travel Trigeminal Neuralgia Extreme Facial Pain Wanted Houston.
No matter what you do please listen to the knowledge of others. My point is that in the NIV of Proverbs 12: 1 "Whoever loves discipline loves knowledge, but he who hates corrections is stupid." I see so many businesses, government agencies, churches, educational institutions, etc. who just really ask questions so they can improve their situations. They trod on wondering when things will ever get better. We all can do better. Let's work together. Make a difference in the world. Share your knowledge. Let me publish your thoughts here. You will be helping you improve in the areas below. It may make someone feel better. Someone else may be able to help you improve your operation. If you need to learn more on how to use your skill to accomplish this let me know. Brian Nelson 713-467-3025. 1ebutuoy 07102007
Check out http://www.PartyTentCity.com We sell new Discount Canopy, Party Tents, Awnings, Camping Tents, & Church Revival tents. For sale are bargain Patio Awning, Portable Garages, Economical Temporary Storage Shelters, Party Canopies and Tents to Rental Companies. We also sell White, Silver Tarpaulins, Mesh Cloth, Shade Cloth, Canopy Kits, Storage Tent, Portable Chuppah, Dome Tents and Awnings. Our canopy kits prices include standard heavy duty rectangular tarps. The steel connects with locking bolts at each port are made for 1" EMT Electrical conduit pipe. We not longer use 3/4 weaker pipe. Fire retardant and Flame Retardant Tarpaulins are available at a premium in limited sizes.
We sell a modular quality tent kit at a fair price. 10x10 can be expanded to a 40x60 with nothing wasted except the tarp. We have hundreds of sizes like 6x8, 10x10, 10x20, 20x20, 20x30, 20x40, 30x30, 30x40, 40x40, 40x50, 40x60 & 50x50.
Flat and Gable Low Peak Connector Fittings for gable roofs are $8 each. ($ 10 if less than 10 are ordered. ) High Peak Roof Connectors are $10. Circus Connectors for Pyramid and Hip roofs are $12. Foot Pads are $ 6 each Ball Bungees are $20/100 White and Silver Tarps are $.12/sq. ft. Fire Retardant Tarps $.24sq. ft.Tent questions? Call me now. Brian Nelson 713-467-3025 M-Sat. 7am-9pm CS SR= Super Reinforced= Strong Upper Triangle. No pole under peak on 20ft clear span models
SD= Super Duper Reinforced= Strong Triangle w/poles every 10 ft.
SRV= Super Reinforced w/ valance using upper side fittings on each outside side pole.
SDV= Super Duper Reinforced w/valance upper side fitting on each outside side pole.
SRV7= Super Reinforced 7'of side tarps on 4 sides and 2 valances.
SDV7= SuperDuper Reinforced 7'side tarps on 4 sides and 2 valances on 4 sides using a 20 ft span. See our tents at http://www.PartyTentCity.com/diagrams40ftwide/60ftlong.html 796 WC to here. (Less)
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