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There is a wide variety of possible causes of neuralgia, and it can affect different parts of the body.

Trigeminal Neuralgia: Angioneuropathy involves pain from the trigeminal nerve, which travels from the brain to the face. It’s believed that a blood vessel presses against the trigeminal nerve at the point where it meets the brainstem.Trigeminal neuralgia causes pain in the face, usually on one side, and is most common in the elderly.

Postherpetic Neuralgia: This type of neuralgia occurs as a complication of shingles and may occur anywhere on the body. Shingles is caused by a virus that causes a blistering rash.There is an increased risk of neuropathy occurring in the area where the shingles outbreak occurred, and it may be mild, moderate, or severe, persistent, or intermittent, and may last for months or years.

Glossopharyngeal Neuralgia: Glossopharyngeal neuralgia produces neck and throat pain. It is not quite as common as cranial neuralgia.

Causes of Neuralgia

Any type of neuralgia is caused by damage to a nerve. Your body’s nerves are covered by a protective sheath called the myelin sheath. When this is damaged or worn away, you experience the stabbing, severe, shock-like pain that is characteristic of neuralgia.

There are numerous factors, including old age, that can cause myelin damage. Unfortunately, the cause of neuralgia is often never determined.

A variety of infections can cause postherpetic neuralgia, including chicken pox, shingles, Lyme disease, and HIV. Syphilis can also trigger the condition.

Multiple Sclerosis: There are many symptoms associated with multiple sclerosis (MS), including facial nerve pain. MS is caused by degradation of myelin.

Pressure on Nerves: Several different pressure sources can wear away the myelin on nerves, including bones, ligaments, blood vessels, and tumors. The pressure of swollen blood vessels is a common cause of trigeminal neuralgia.

Diabetes (Diabetic Neuropathy):There is a high probability that people with diabetes will experience some form of neuralgia because excess glucose in the bloodstream can damage the myelin.

Less Common Causes: In cases where neuralgia cannot be attributed to infections, multiple sclerosis, diabetes, or pressure on the nerves, it may be due to one of many less common factors. These include:

  • chronic kidney disease
  • porphyria (a rare blood disease)
  • medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
  • trauma, such as that caused by surgery
  • chemical irritation
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How to deal with Scalp Lacerations with this “HAT” trick!

How many of you have heard of the Hair Apposition Technique, or perhaps even used it on a patient? I figured it existed since 2002, but have only learned about it recently!

Hair Apposition Technique, or HAT trick, is a creative method of approximating the scalp lacing by using the patient’s own hair as sutures.

Let me explain the steps:

  1. Irrigate your wound as usual, inspect for foreign bodies
  2. Pull together 3-7 strands of hair on one side of the wound.
  3. Do the same on the other side of the wound.
  4. Twist these two hair bundles in 360-degree revolutions. Do not tie a knot
  5. Secure the intertwined hair bundles by applying a few drops of Dermabond.
  6. Repeat as needed to close the length of the laceration.

If your patients have short hair, don’t worry, you can still use the HAT trick; all you need is two pairs of clamps.

Traditional staples/sutures have 3 advantages over them : 1) Zero pain (especially useful in kids; just tell them you’re braiding their hair!) 2) No need to anesthetize the wound (forget waiting for your nurses to first apply LET, then waiting more for it to kick in) 3) No need to return to ED for removal! The hair will unravel on its own after a week.

A quick tip for preventing loose hairs from entering your field of repair! When you try to staple Goldberg’s latest scalp lac and his hair keeps falling in, try using petroleum-based ointment instead. Apply ultrasound jelly (or grease) around the area to smooth down the strands, and spread them out to the sides as follows:

Using this method, you will not only be able to visualize the lac more clearly, but you will also be able to avoid trapping hair within the lac, which could cause wound dehiscence, a foreign body reaction, or local cellulitis.

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Foot drop can be treated through peroneal or tibial nerve transfer operations

Patients with foot drop have difficulty lifting the front part of their foot and toes. Despite its debilitating nature, current treatment options are limited. 

The term “foot drop” may seem simple, but it describes an often-complicated condition in which the foot is unable to elevate at the ankle, resulting in difficulty walking and a floppy appearance. Foot drop is caused by a number of factors, but one important factor is damage to the nerves controlling the leg muscles that bend and lift the front part of the foot and toes.As a result, people either drag their feet and toes or walk with high steps referred to as the ‘steppage’ gait.Foot drop often leads to pain or discomfort neurological symptoms, such as tingling or burning. This way of walking requires more effort and in time may lead to other problems, such as back or hip pain.

The peroneal nerve is a group of muscles that runs from the back of the knee around to the front of the shin and provides movement (motor control) and sensation to the lower leg, foot, and toes.Moreover, as this nerve supplies the tibialis anterior muscle (TAM), which lifts the foot, any damage disrupting the motor control pathway between the peroneal nerve and TAM can result in foot drop.Consequently, the peroneal nerve can be damaged by injuries such as sports injuries, gunshot wounds, hip replacements, childbirth, or diabetic complications as it lies close to the surface of the skin.Foot drop can also be caused by multiple sclerosis, a stroke, spinal cord damage, or cerebral palsy.

Handling foot drop ups and downs

Figure 1: The incision at the popliteal fossa.

The extent and cause of foot drop determine the types of treatment available. An orthosis (ankle-foot orthosis) can be fitted to help support the foot and improve walking ability, but many users find them uncomfortable and unhygienic.

Nerve stimulators, which apply small electrical charges to the leg, can help some patients gain more mobility. If the nerve does not recover, surgical treatment may be considered. Peroneal nerve decompression is an option for compressed nerves, or tendons may be transferred from one leg to another.In general, however, foot drop is difficult to treat successfully due to the small size of the nerve that is involved (less than 6cm). Nerve grafting is therefore a limited treatment option.

Exposition of the peroneal nerve at the popliteal fossa. (B) A cross-section showing the direction of the fibers to the tibialis anterior at the popliteal fossa.

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