trigeminal nerve damage--unilateral or bilateral presentation?

[BluegrassRN]

I'm completing my BSN, and I have a question that my instructor cannot apparently answer, or perhaps I am not presenting my question clearly, and thus she does not know what I am asking.

In any case, we had a question on a test that stated that a patient was experiencing decreased sensation on her bilateral cheeks.

The correct answer for the cause was trigeminal nerve damage. I specifically did not pick that because I thought that trigeminal nerve damage would result in only unilateral decreased sensation. My book and on line resources are vague on the issue, discussing mainly the motor or pain aspects of trigeminal nerve damage, and indeed, those appear to be unilateral in presentation. I do not see, however, where it discusses whether decreased sensation would be unilateral or bilateral.

Could someone who knows or understands more than me help me out here?

Thanks so much.

[really]

Off the top of my head, my inclination was to say it's unilateral, but I decided to look a little further.

From Barker's text on Neuroscience Nursing (pg. 505):

"Right-sided nerve involvement is found twice as often as left-sided involvement and rarely bilaterally. This disorder is characterized by sudden, severe, electric shock-like or stabbing pain, typically felt on one side of the jaw or cheek."

So, I guess the answer to your question is it's typically one-sided, but rarely it can be bilateral. Hope that helps.

Just curious, what were the other options? Sounds like it was a bad question, unless she specifically addressed the "sidedness" of the disorder.

[BluegrassRN]

The question was very lame. Something short with not much information. "The patient is unable to differentiate sensation on bilateral cheeks. The nurse suspects:"

Frostbite with resultant paresthesia to the cheeks

Trigeminal nerve damage

Two other options that were obviously not right.

The bilateral really threw me off, and so I chose frostbite. I'm just trying to understand the hows behind a bilateral presentation.

I hate my school. It's really terrible, with little to no feedback, completely teach yourself. With rare exceptions, my instructors rarely answer my questions, and when they do they simply refer me to the book--even when I've already explained I have LOOKED in the book, and on the internet, and asked my fellow nurses....I'm too far in to transfer, but you bet I won't be recommending my program to anyone, and I sure won't be giving them money for my masters.

There's a reason why some programs are cheaper than other, folks. I'd stay clear of Fort Hays State University, if I were you. In my desperation to find an affordable online program, I did not listen to the criticisms of some of my fellow coworkers who had previously attended their program. I am certainly regretting that decision now.

Sorry for the off-topic rant. Thanks *so much* for your response and for the citation!

[nicole109]

I don't have a book citation, but I worked in neuro for 5 years, and I never once saw trigeminal nerve damage present bilaterally. I'm not saying it can't happen, but I never saw it...I would fight the question, especially if someone else on here was able to give you a book citation.

[Lucky0220]

I too, went to nursing school in KY. It was a private school in Louisville with a fairly poor reputation. My first year was great, the LPN year. I bridged through for the RN program, and the instructors were horrible. If not for a great MedSurg instructor that I had for 3 out of 4 quarters in my first year, I doubt that I would have learned anything! I know abut tests like the ones you just had. Teachers get their exams from the textbooks' test bank; they don't bother to make them up themselves and that is why they usually cannot give you a good rationale for the answer. This happened all the time at my school. Very frustrating. The only reason why I would not have picked frostbite, was that it said "loss of sensation in the cheeks due to" and loss of sensation usually does involve the nerve or nerves in that area. The trigeminal nerve does branch off to both sides of face and mouth. Still, an awful question. Hope you have more success with your subsequent exams.:redbeathe

[kyzeke]

While most cases are unilateral it is possible for it to present bilaterally. Unfortunately, I know of this because I happen to be one of the unlucky few who presents with pain and decreased sensation bilaterally. Lucky me!

[BluegrassRN]

kyzeke, do you mind me asking what sort of issue caused your trigeminal nerve pain? So far all I could come up with was some sort of autoimmune issue such as MS, and a stroke. Any other potential causes?

Thanks for the info!

[kyzeke]

The neurosurgeon I see believes it resulted from a botched root canal. I know that sounds weird, but if you go online, their are numerous cases of people that were diagnosed with this disease after root canals!