Review Question - QID 109895

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Cranial Nerves Introduction QID: 109895 (M1.NE.18.4872)

QID 109895 (Type "109895" in App Search)

A 27-year-old woman presents to a neurologist complaining of facial pain. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes. The pain is severe enough to completely stop her from her activities. She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome. She takes an oral contraceptive pill. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive. Her pupils are 2 mm and reactive to light bilaterally. Fundoscopic examination is unremarkable. Her strength and range of motion are full and symmetric in her upper and lower extremities. This patient’s symptoms are likely due to irritation of a nerve that passes through which of the following foramina?

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Foramen magnum

10/158

Foramen rotundum

67%

106/158

Inferior orbital fissure

12/158

Jugular foramen

5/158

Superior orbital fissure

11/158

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The patient in this vignette presents with facial pain suggestive of trigeminal neuralgia. This condition is caused by irritation to the V2 or V3 branches of the trigeminal nerve, the former of which passes through the foramen rotundum.

Trigeminal neuralgia is a chronic pain disorder characterized by sudden episodic severe unilateral facial pain. The pain typically lasts for seconds to minutes and may be triggered by touch or pressure. The condition is believed to arise from irritation to either of the 2 inferior divisions of the trigeminal nerve: V2 (maxillary division) and V3 (mandibular division). These nerves pass through the foramen rotundum and foramen ovale, respectively.

Incorrect Answers:
Answer 1: The foramen magnum lies at the base of the skull and is the passage through which the spinal cord descends. The contents of the foramen magnum include the medulla, meninges, and spinal accessory nerve (CN XI).

Answer 3: The inferior orbital fissure is formed by the sphenoid bone and maxilla and functions to separate the floor and lateral wall of the orbit. It also transmits the zygomatic branch of the maxillary nerve (CN V2).

Answer 4: The jugular foramen lies at the base of the skull behind the carotid canal. The glossopharyngeal nerve (CN IX), vagus nerve (CN X), spinal accessory nerve (CN XI), and the internal jugular vein pass through the jugular foramen.

Answer 5: The superior orbital fissure lies between the lesser and greater wings of the sphenoid. Several important structures pass through the fissure including the oculomotor nerve (CN III), trochlear nerve (CN IV), branches of the ophthalmic nerve (CN V1), and abducens nerve (CN VI).

Bullet Summary:
Trigeminal neuralgia is caused by irritation to the maxillary (V2) and mandibular (V3) branches of the trigeminal nerve which exit the skull via the foramen rotundum and foramen ovale, respectively.

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