Trigeminal Neuropathy in Dogs

Which of the following is most commonly affected by trigeminal neuropathy?

Which clinical sign is typically associated with trigeminal neuropathy in dogs?

What percentage of dogs with trigeminal neuropathy exhibit sensory deficits?

What diagnostic tool is recommended to rule out tumors as a cause of trigeminal neuropathy?

How long does it typically take for dogs with idiopathic trigeminal neuropathy to recover?

What is a common clinical presentation in dogs affected by nerve sheath tumors of CNV?

Which of the following is a possible treatment option for nerve sheath tumors of CNV?

What is a typical characteristic of idiopathic facial nerve paralysis in dogs?

Which breed is predisposed to idiopathic facial nerve paralysis?

What clinical sign is associated with idiopathic facial nerve paralysis?

Approximately what percentage of dogs with idiopathic facial nerve paralysis will have the other side of their face affected months later?

Which of the following diagnostic tests is helpful when diagnosing idiopathic facial nerve paralysis?

What type of nystagmus is characteristic of central vestibular disease?

Which of the following is a clinical sign of vestibular disease?

What is the discharge rate of the peripheral vestibular system at rest?

Which of the following structures is part of the central vestibular system?

Which cranial nerves have a connection to the medial longitudinal fasciculus (MFL)?

In otitis media/interna, how does infection typically reach the bulla tympanica?

Which bacterium is commonly associated with otitis media/interna?

Which of the following is a typical clinical sign of otitis media/interna?

Which diagnostic tool is commonly used to assess the bulla in cases of suspected otitis media/interna?

What does myringotomy involve in the diagnosis of otitis media/interna?

What long-term treatment option can be prescribed for otitis media/interna?

What is the typical signalment for dogs that have idiopathic vestibular syndrome?

What is the most common clinical sign for idiopathic vestibular syndrome in dogs?

What is a key characteristic of the clinical signs associated with idiopathic vestibular syndrome?

Which of the following clinical signs would NOT generally be associated with idiopathic vestibular syndrome?

What underlying pathogenic cause is associated with idiopathic vestibular syndrome?

How long does it typically take for a dog to recover from idiopathic vestibular syndrome?

Which of the following should be ruled out when diagnosing idiopathic vestibular syndrome?

In addition to supportive care, what medication can be used to help a dog with idiopathic vestibular syndrome?

What is the most common cause for cranial nerve disorders?

Which of the following best represents the general prognosis for properly diagnosed and treated cranial nerve disorders?

In the context of nerve sheath tumors affecting cranial nerve V (CNV), which histological subtype indicates a tumor originating from the myelin-producing cells?

Which of these conditions is least likely to be included when establishing a differential diagnosis for canine idiopathic vestibular syndrome?

If a dog presents with acute onset of head tilt, ataxia, and spontaneous nystagmus, differentiating between peripheral and central vestibular disease is crucial. Which of the following clinical signs is MOST indicative of central vestibular disease rather than peripheral?

In an 8-year-old Maltese presenting with signs suggestive of a nerve sheath tumor of CN V, which advanced imaging modality, combined with specific contrast enhancement protocols, would offer the highest sensitivity for visualizing the extent of tumor invasion along the trigeminal nerve pathway?

What type of nystagmus is commonly associated with vestibular disease?

Which of the following is a potential etiology for trigeminal neuropathy in dogs?

What clinical presentation is more commonly observed in cases of otitis media/interna?

Besides supportive care, which medication types are typically used in the treatment of idiopathic vestibular syndrome?

What is a diagnostic tool used to evaluate the bulla tympanica for otitis media/interna?

Which of the following is a typical clinical sign observed in dogs affected by trigeminal neuropathy?

Which of the following is a possible route of bacterial infection leading to otitis media/interna?

What diagnostic test involves obtaining samples for cytological analysis and culture sensitivity when diagnosing otitis media/interna?

What is the underlying cause of idiopathic vestibular syndrome?

In cases of nerve sheath tumors affecting CN V, which clinical sign is more indicative of tumor progression rather than inflammation or idiopathic neuropathy?

Which imaging modality provides superior detail for assessing the extent of nerve sheath tumors of CNV?

What differentiates central from peripheral vestibular disease based on the type of nystagmus observed?

Considering the anatomical course of the facial nerve, which clinical sign, if present alongside idiopathic facial nerve paralysis, would suggest potential involvement of the vestibular system?

Which of the following characteristics of nystagmus would be MOST concerning for central vestibular disease rather than peripheral vestibular disease in a canine patient?

A veterinary neurologist is evaluating a dog with suspected idiopathic trigeminal neuropathy. Electromyography (EMG) is performed on the muscles of mastication. What EMG finding would be MOST consistent with this diagnosis in the acute phase?

What is the primary sensory function of the trigeminal nerve (CNV)?

Why does bilateral trigeminal neuropathy typically result in a dropped jaw in dogs?

Which aspect of the eating process is most affected in dogs with a dropped jaw due to trigeminal neuropathy?

Why is dehydration a significant concern in dogs with trigeminal neuropathy?

How are sympathetic fibers connected to the trigeminal nerve, leading to Horner's syndrome in some cases of trigeminal neuropathy?

Which diagnostic imaging modality is most useful for identifying nerve sheath tumors affecting the trigeminal nerve?

What is the primary focus of treatment for idiopathic trigeminal neuropathy?

How can owners provide hydration to dogs with trigeminal neuropathy that are having difficulty drinking?

What is the significance of positional vestibular strabismus and vertical nystagmus in the diagnosis of trigeminal neuropathy?

What is the significance of muscle atrophy affecting the muscles of mastication, such as the temporal and masseter muscles?

Why is surgical resection of nerve sheath tumors affecting cranial nerve V (CNV) considered difficult?

Aside from motor and sensory functions, what other function can be affected by facial nerve (CN VII) dysfunction?

What clinical sign is LEAST likely to be associated with facial nerve (CN VII) paralysis?

Why is an otitis media-interna considered an important differential diagnosis for facial nerve paralysis?

What is the typical timeframe for improvement in cases of idiopathic facial nerve paralysis?

What is an important consideration when managing dogs with facial nerve paralysis to prevent corneal damage?

If a dog recovers from facial nerve paralysis and then develops the same condition on the opposite side months later, what is the likely explanation?

What is the function of the semicircular ducts within the vestibular system?

Which of the following is an effective method to accentuate nystagmus during a neurological examination?

What combination of clinical signs is most indicative of peripheral vestibular disease rather than central vestibular disease?

What is the most likely method by which bacteria reach the middle ear in cases of otitis media?

What diagnostic imaging modality is best for visualizing the inner ear organs (succulus, utriculus, cochlea) and detecting changes associated with otitis interna?

Which of the following is a major advantage of using ultrasound to diagnose otitis media?

What is the main therapeutic approach for managing cases of idiopathic vestibular syndrome?

What differentiates idiopathic vestibular syndrome from other vestibular conditions?

Which of the following would be an appropriate medication to administer to a dog suffering from idiopathic vestibular syndrome to reduce nausea?

What is the typical expected timeframe for seeing improvement with supportive care in cases of idiopathic vestibular syndrome?

Which clinical sign helps differentiate otitis media/interna from idiopathic vestibular syndrome?

What is a common long-term treatment strategy for otitis media/interna when medical management is insufficient?

Why is it important to rule out conditions like otitis media/interna, tumors, and strokes when diagnosing idiopathic vestibular syndrome?

In companion animals, what are tumors arising from nerve tissues generally classified as?

What should be the next diagnostic step if a 10-year-old dog has a acute onset of having a dropped food, and vestibular signs (positional vestibular strabismus and nystagmus)?

Which of the following is most common cranial nerve disorder?

What is an important aspect to consider when assessing the bulla with a CT scan?

What is thought to be the etiology of vestibular disease in older dogs?

When performing a spinal fuild tap on a dog, what finding would indicate lymphoma?

Which of the following conditions typically shows improvement in 24 to 72 hours?

In dogs with trigeminal neuropathy and concurrent Horner's syndrome, what anatomical relationship explains the connection between cranial nerve V and the sympathetic fibers?

Besides nerve sheath tumors, what are other important differential diagnoses to consider when presented with a dog showing clinical signs of trigeminal neuropathy?

What is the primary reason for emphasizing hydration in the supportive care of dogs with trigeminal neuropathy?

Why is it important to avoid using a full neurological exam as a shortcut, even if you see a dropped jaw in dogs?

Why might surgical resection of nerve sheath tumors affecting the trigeminal nerve be considered difficult?

What is the significance of observing positional vestibular strabismus and vertical nystagmus during a neurological examination?

What is one of the main differences in the underlying signs that can help differentiate between dogs affected by trigeminal neuropathy compared to nerve sheath tumors?

What is an important aspect to consider when managing dogs with facial nerve paralysis to prevent corneal damage?

What are the possible etiologies for a facial nerve paralysis?

What makes otitis media-interna an important differential diagnosis for facial nerve paralysis?

What is the primary function of the semicircular ducts within the vestibular system?

If spontaneous nystagmus is not readily apparent during a neurological examination, what technique can be used to accentuate or trigger it?

What clinical signs, when observed together, are MOST suggestive of peripheral vestibular disease rather than central vestibular disease?

What is the most likely route by which bacteria reach the middle ear in cases of otitis media?

What is a major advantage of using an MRI to diagnose otitis media/interna compared to a CT scan or radiographs?

How does ultrasound aid in the diagnosis of otitis media?

What is the most important aspect to consider when managing cases of idiopathic vestibular syndrome?

What is a common characteristic of idiopathic vestibular syndrome?

Which clinical sign should be absent with uncomplicated geriatric vestibular syndrome? Select the MOST appropriate answer.

What type of medication is most appropriate to administer to a dog suffering from idiopathic vestibular syndrome to reduce nausea?

What should be the next step if a 10-year-old dog has an acute onset of neurological deficits (dropped food, positional vestibular strabismus, and nystagmus)?

If a dog recovers from facial nerve paralysis and then develops a similar condition on the opposite side months later, which of the following explanations is most likely?

Which diagnostic imaging modality is MOST suitable for visualizing the tympanic bulla?

Why are medium to larger dog breeds more frequently affected by geriatric vestibular syndrome?

In the vast majority of isolated coranial nerve deficits, what is the recommended treatment?

What should be included as an important rule out for geriatric vestibular syndrome?

What is the expected prognosis regarding appropriate diagnosis and treatment for cranial nerve disorders?

In a dog presenting with trigeminal neuropathy and exhibiting a dropped jaw, what is the primary reason for the difficulty in forming a food bolus?

If a dog is diagnosed with trigeminal neuropathy and exhibits hypersalivation, what is the most likely explanation for this clinical sign?

Why is dehydration a critical concern in dogs with trigeminal neuropathy?

In cases of trigeminal neuropathy, the sympathetic fibers 'borrow' cranial nerve V to reach the eye. Which artery do they initially follow before associating with the trigeminal nerve?

When diagnosing trigeminal neuropathy, what is the primary reason for performing an MRI?

What is the general consensus regarding the use of prednisone in treating idiopathic trigeminal neuropathy?

When providing supportive care for a dog with trigeminal neuropathy, why is it recommended to administer water via a syringe directed towards the larynx/pharynx?

In instances of trigeminal neuropathy where Horner's syndrome is concurrently observed, which anatomical relationship explains the connection between cranial nerve V and the sympathetic fibers?

What is the most critical aspect of supportive care for dogs diagnosed with trigeminal neuropathy?

In cases of nerve sheath tumors affecting the trigeminal nerve (CN V), why might a dropped jaw not be observed?

Why is surgical resection of nerve sheath tumors affecting cranial nerve V (CNV) considered a challenging procedure?

When presented with a dog exhibiting a dropped jaw and suspected trigeminal neuropathy, why should a full neurological exam be performed, rather than relying solely on the presence of this clinical sign for diagnosis?

In cases of facial nerve paralysis secondary to otitis media/interna, what is the most direct mechanism by which the facial nerve function is compromised?

If nystagmus is not readily apparent during a neurological examination for suspected vestibular disease, what provocative technique can be used to help identify positional nystagmus?

What is the significance of lubricating the eye in dogs with facial nerve paralysis?

Which part of the vestibular system is primarily responsible for sensing rotational movements of the head?

A cat is presented with vestibular signs. During the neurological examination, you do not observe nystagmus initially. What technique can be used to better assess for nystagmus?

What is the primary route by which infections typically spread to the middle ear, leading to otitis media?

What are the major advantage of using ultrasound to aid in the diagnosis of otitis media?

What is the recommended approach for managing most cases of idiopathic vestibular syndrome?

A dog is diagnosed with idiopathic vestibular syndrome. What would be an appropriate medication to administer to help reduce nausea?

Why is it important to rule out specific conditions when diagnosing idiopathic vestibular syndrome?

What is the common term used in veterinary medicine for tumors arising from nerve tissues?

Which of the following would warrant further diagnostics, such as advanced imaging or a spinal fluid tap, to rule out more serious differentials like neoplasia or inflammatory disease?

When assessing the bulla with a CT scan for potential otitis media/interna, what is an important aspect to consider?

What is a proposed etiology of idiopathic vestibular syndrome in older dogs that is similar to Meniere's disease in humans?

Following otic causes, what disease should be considered when a geriatric dog presents for acute vestibular signs?

What clinical sign of facial nerve (CN VII) dysfunction would suggest the nerved innervating the salivary glands is affected?

What clinical sign of otitis media/interna may indicate the facial nerves are implicated?

In order to manage a corneal ulcer effectively, what needs to happen?

During the neurological examination for vestibular system issues, how can you trigger a nystagmus?

What key factor(s) can help differentiate between central and peripheral vestibular disease?

After assessing a cat that presents with a head tilt tot he right side and has a right-sided Horner's with horizontal nystagmus, what is your diagnosis?

To help support a medical management plan, how long should antibiotics be admnistered?

In companion animals what age is common for idiopathic vestibular syndrome to appear?

What clinical sign during the exam is NOT common in Idiopathic vestibular syndrome?

How can you increase the likelihood of seeing nystagmus on a dog?

Which of the following treatment options is NOT as interventional as the others?

Most cranial nerve disorders are treated with supportive care; what disorder involves interventional procedures?

Loss of muscle mass is a typical finding of lower motor neuron disease. What is innervated when there is a loss of muscle mass?

After how long can you see an improvement with supportive care of geriatric vestibular syndrome?

In trigeminal neuropathy, why is it critical to address dehydration quickly?

When presented with a dog exhibiting a dropped jaw and suspected trigeminal neuropathy, why is it important to perform a complete neurological exam?

In cases of nerve sheath tumors affecting the trigeminal nerve (CN V), why might a dropped jaw not always be observed?

If spontaneous nystagmus is not readily apparent during a neurological examination for suspected vestibular disease, what provocative technique can be used to help identify positional nystagmus?

What is a common hallmark of otitis media/interna?

In order to manage a corneal ulcer effectively due to facial nerve paralysis, what needs to happen?

What is the common signalment/age for idiopathic vestibular syndrome?

During a neurological exam of a dog with vestibular signs, what should you do to see nystagmus?

A dog presents with a dropped jaw, hypersalivation, and difficulty eating. While trigeminal neuropathy is suspected, what additional clinical sign would warrant further investigation to rule out nerve sheath tumor involvement, rather than idiopathic neuropathy?

When differentiating between peripheral and central vestibular disease, what is the significance of proprioceptive deficits?

In a dog presenting with acute vestibular signs, including head tilt and nystagmus, which of the following historical or clinical findings would make idiopathic vestibular syndrome less likely, prompting further investigation for other causes?

A veterinary technician is educating an owner about supportive care for a dog diagnosed with idiopathic trigeminal neuropathy. Which of the following instructions is MOST crucial to emphasize to prevent a life-threatening complication?

When performing advanced imaging (CT or MRI) to assess the bulla tympanica for potential otitis media/interna, what is the MOST important factor to consider for accurate interpretation?

Which of the following is the MOST consistent clinical sign associated with nerve sheath tumors of cranial nerve V (CNV)?

What is the BEST initial treatment option for trigeminal neuritis?

Which of the following is the MOST common clinical presentation of trigeminal neuritis in dogs?

Which diagnostic test is MOST useful for confirming denervation of the muscles of mastication in trigeminal neuritis?

A dog presents with a dropped jaw, difficulty eating, and muscle atrophy of the temporalis and masseter muscles. Which of the following differentials is LEAST likely?

Which of the following best describes the typical nystagmus associated with peripheral vestibular disease?

What is the MOST characteristic finding differentiating peripheral from central vestibular disease regarding proprioceptive deficits?

Which of the following clinical signs, if present with facial nerve paralysis, would MOST strongly suggest involvement of the central nervous system rather than idiopathic facial nerve paralysis?

What aspect of the history is MOST important to differentiate geriatric vestibular disease from other causes of vestibular signs?

In a dog presenting with acute vestibular signs, including head tilt and nystagmus, which historical element would make geriatric vestibular syndrome LESS probable, thus meriting more investigation?

What is the MOST appropriate duration of antibiotic therapy for treating otitis media/interna in dogs and cats?

If a dog is diagnosed with idiopathic facial paralysis and develops keratitis sicca, what is the MOST important step to include in the treatment plan?

What condition MUST be ruled out as a possibility for geriatric vestibular syndrome?

A 10-year-old dog presents with acute onset of head tilt, nystagmus, and ataxia. After ruling out otitis media/interna, what diagnostic step is MOST crucial to consider next?

In a patient exhibiting signs of a unilateral peripheral vestibular lesion, you notice the head tilt, nystagmus, and falling to one side. However, you also note the presence of postural reactions and proprioceptive deficits on the opposite side of the body from the lesion. Where is the lesion MOST likely located?

What is the primary function of the trigeminal nerve (CNV)?

In dogs with trigeminal neuropathy, bilateral involvement typically results in which clinical sign?

What is the primary concern regarding water uptake in dogs with a dropped jaw due to trigeminal neuropathy?

In addition to a dropped jaw, what other clinical sign is seen in approximately 10% of dogs with trigeminal neuropathy?

Which of the following diagnostic imaging modalities is MOST useful for ruling out nerve sheath tumors in dogs suspected of having trigeminal neuropathy?

What is the MOST appropriate initial treatment for idiopathic trigeminal neuropathy?

Which of the following best explains the connection between cranial nerve V and the sympathetic fibers, leading to Horner's syndrome in some dogs with trigeminal neuropathy?

Which of the following best describes how to provide hydration to a dog with trigeminal neuropathy and a dropped jaw?

When presented with a dog exhibiting a dropped jaw, hypersalivation, and difficulty eating, why is it essential to perform a complete neurological exam?

Which clinical sign associated with nerve sheath tumors affecting the trigeminal nerve (CN V) is LEAST common?

A dog is presented with a dropped jaw, difficulty eating, and muscle atrophy of the temporalis and masseter muscles. Which diagnostic test is MOST useful for confirming denervation of the muscles of mastication?

What is the primary goal of supportive care for dogs diagnosed with trigeminal neuropathy?

When presented with a dog exhibiting a dropped jaw and suspected trigeminal neuropathy, what is the primary reason for performing an MRI?

A 6-year-old Golden Retriever presents with acute onset of a dropped jaw and difficulty eating. You suspect trigeminal neuropathy. What is the MOST appropriate next step in managing this case?

What is the MOST likely cause of hypersalivation in a dog with trigeminal neuropathy?

What aspects of cranial nerve VII function can be affected?

The tear production can be suppressed by which cranial nerve?

What is the most important aspect to consider when managing dogs with facial nerve paralysis to prevent corneal damage?

What is the significance of an otitis media-interna relating to facial nerve paralysis?

Following a diagnosis of facial nerve paralysis, it's found that there is issues with the salivary glands, what can be inferred?

Besides supportive care, what treatment can be implemented to help address keratitis due to lack of tear production?

What is the significance of positional pathological nystagmus?

Which choice is the LEAST likely option to see when examining a cat?

What are the MAJOR advantage of using MRI to diagnose otitis media/interna compared to a CT scan or radiographs?

Which cause requires interventional treatment versus just supportive care?

In older dogs with idiopathic vestibular disease, what is the hallmark sign?

If you suspect a geriatric dog is suffering from idiopathic vestibular syndrome, what is an important point to rule out?

What factors help differentiate between central and peripheral vestibular disease?

Which cranial nerve is primarily responsible for both sensory innervation of the face and motor control of the muscles of mastication?

A dog presents with a sudden onset of dropped jaw, making it difficult to eat and drink. Bilateral trigeminal neuropathy is suspected. What is the most immediate and critical aspect of supportive care for this patient?

In trigeminal neuropathy, the sympathetic fibers destined for the eye 'hitchhike' along which major artery before associating with cranial nerve V?

Which of the following clinical signs is LEAST likely to be associated with a nerve sheath tumor affecting the trigeminal nerve (CN V)?

Idiopathic facial nerve paralysis in dogs is characterized by dysfunction of cranial nerve VII. Which of the following is a common clinical sign?

While idiopathic facial nerve paralysis is often self-limiting, what is a critical aspect of management to prevent potential complications?

In cases of facial nerve paralysis secondary to otitis media/interna, how does the infection most directly lead to nerve dysfunction?

A veterinary neurologist suspects vestibular disease in a dog. During the neurological exam, spontaneous nystagmus is not immediately apparent. What technique can be employed to accentuate or trigger nystagmus?

When differentiating between peripheral and central vestibular disease, which of the following clinical findings is MOST indicative of central vestibular disease?

Otitis media is most commonly caused by bacteria entering the middle ear via which route?

Which imaging modality provides the most detailed visualization of the inner ear structures (succulus, utriculus, cochlea) and soft tissues, making it superior for diagnosing otitis interna?

Ultrasound can be a useful screening tool for otitis media. What finding during an ultrasound examination of the bulla suggests the presence of otitis media?

What is the cornerstone of treatment for idiopathic vestibular syndrome in dogs?

Idiopathic vestibular syndrome is characterized by an acute onset of vestibular signs. Which of the following clinical signs would be UNEXPECTED in uncomplicated idiopathic vestibular syndrome?

Which medication is most appropriate for reducing nausea associated with idiopathic vestibular syndrome?

If a 10-year-old dog presents with acute onset vestibular signs (head tilt, nystagmus, ataxia) and a dropped jaw, what is the MOST appropriate next diagnostic step to differentiate between idiopathic vestibular syndrome and more serious conditions?

What is the most likely explanation if a dog recovers from facial nerve paralysis and then develops facial paralysis on the opposite side several months later?

Which imaging modality is GENERALLY considered MOST suitable for visualizing the tympanic bulla in dogs and cats suspected of otitis media/interna?

Why are medium to larger breed dogs reportedly more frequently affected by geriatric vestibular syndrome compared to small breeds?

In the vast majority of isolated cranial nerve deficits, what is the recommended PRIMARY treatment approach?

Which of the following conditions is an important 'rule-out' when diagnosing geriatric vestibular syndrome?

What is the general prognosis for cranial nerve disorders that are properly diagnosed and treated, according to the provided text?

In a dog with trigeminal neuropathy exhibiting a dropped jaw, what is the primary reason for the difficulty in forming a food bolus?

If a dog with trigeminal neuropathy exhibits hypersalivation, what is the MOST likely explanation for this clinical sign?

Why is dehydration a critical concern in dogs with trigeminal neuropathy and a dropped jaw?

When diagnosing trigeminal neuropathy, what is the primary reason for performing an MRI, even though it is often considered idiopathic?

What is the general consensus regarding the use of prednisone (a corticosteroid) in treating idiopathic trigeminal neuropathy?

In cases of nerve sheath tumors affecting the trigeminal nerve (CN V), why might a dropped jaw NOT always be observed initially?

A cat presents with vestibular signs. During the neurological examination, you do not observe nystagmus initially. What technique can be used to better assess for nystagmus in this cat?

What is a major advantage of using ultrasound to aid in the diagnosis of otitis media, compared to CT or MRI?

Which of the following would warrant further diagnostics, such as advanced imaging or a spinal fluid tap, in a dog presenting with acute vestibular signs?

When assessing the bulla with a CT scan for potential otitis media/interna, what is an important aspect to consider for accurate interpretation?

Following otic causes, what disease should be considered as a primary differential in a geriatric dog presenting with acute vestibular signs?

What clinical sign of facial nerve (CN VII) dysfunction would suggest the branch innervating the salivary glands has been affected?

What clinical sign of otitis media/interna may indicate involvement of the facial nerve?

In dogs with trigeminal neuropathy, sympathetic fibers connect to cranial nerve V. Which artery do these sympathetic fibers initially follow before associating with the trigeminal nerve?

When distinguishing between idiopathic trigeminal neuropathy and a nerve sheath tumor affecting cranial nerve V (CNV), which clinical observation would be more indicative of a nerve sheath tumor?

What is the rationale behind the recommendation to avoid full neurological exams when assessing cranial nerve disorders?

In addition to the typical clinical signs, what atypical finding would MOST strongly suggest the presence of a complex case beyond idiopathic trigeminal neuropathy?