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Continuum Health Group
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Cranial nerves & neurological assessment

Facial pain, trigeminal neuralgia and facial spasm, and assessment of headaches, seizures, memory, balance and movement problems where a structural or surgically treatable cause may be involved.

By appointment

Available at this clinic

Our services

Trigeminal Neuralgia, Facial Pain & Hemifacial Spasm

Trigeminal neuralgia causes sudden, severe, electric-shock-like pain in the face, often set off by touching the face, eating, talking or brushing the teeth. Hemifacial spasm causes involuntary twitching or tightening of the muscles on one side of the face. In some people, both conditions are linked to a blood vessel pressing on a nerve where it leaves the brainstem; other causes include tumours, multiple sclerosis and other structural problems.

Assessment includes a detailed history, a neurological examination and usually an MRI scan to look for nerve compression or another cause. Many people are first treated with medicines. Where medicines do not control symptoms, cause side effects, or a structural cause is found, other treatments may be discussed, depending on the condition.

  • Trigeminal neuralgia
  • Other facial pain where a structural or nerve cause is suspected
  • Hemifacial spasm
  • Glossopharyngeal neuralgia and other selected cranial nerve pain
  • Facial pain or spasm caused by a tumour pressing on a nerve
  • Review after previous treatment for facial pain or spasm

How it is assessed

Dr Chou asks about the pattern of pain or spasm, what triggers it and how it has responded to treatment so far. MRI, sometimes with detailed views of the nerves and nearby blood vessels, helps show whether a vessel or another lesion is pressing on the nerve.

Treatment options

Depending on the condition and how it has responded to medicines, options may include continuing or adjusting medicines, microvascular decompression surgery for selected patients, percutaneous trigeminal treatments, stereotactic radiosurgery arranged with partner centres, or injections to ease facial spasm.

Headache, Seizures & Structural Neurological Assessment

Most headaches and many neurological symptoms are not caused by a problem that needs surgery. A neurosurgical assessment may be helpful where symptoms are persistent or getting worse, come with other neurological signs, or where a scan has shown something that needs explaining.

The assessment looks for structural or surgically treatable causes, such as a tumour, cyst, blood vessel abnormality or problem with the flow of cerebrospinal fluid (the fluid around the brain and spinal cord). It usually includes a neurological examination and brain imaging such as MRI or CT. Where the cause is not surgical, care may continue with neurology or other specialists.

  • Persistent, progressive or unusual headaches
  • Headaches with neurological symptoms or findings
  • Seizures where structural brain disease is suspected
  • Hydrocephalus and other cerebrospinal-fluid disorders
  • Cysts and other incidental findings on brain scans
  • Unexplained neurological symptoms that need imaging review

Headaches

Specialist assessment may be appropriate where headaches are persistent, progressive, associated with neurological findings or where an underlying structural cause is suspected. Assessment may include brain imaging and further specialist investigation.

Seizures and epilepsy

Patients with seizures may be evaluated where structural brain disease or a possible neurosurgical cause is suspected. Where appropriate, this may include further imaging and multidisciplinary neurological assessment with a neurologist.

Memory, Balance & Movement Assessment

Changes in memory, walking, balance or movement are often managed by neurologists and geriatricians. Sometimes, though, they are caused by a structural problem in the brain that may be treatable, such as normal pressure hydrocephalus, a slowly growing tumour or a chronic subdural haematoma (a collection of old blood on the surface of the brain).

A neurosurgical assessment looks at your symptoms, examination findings and brain imaging to see whether a structural cause is present, and whether treatment for it may help. Where the main problem is not surgical, you are referred to or co-managed with neurology, geriatric medicine or other appropriate specialists.

  • Normal pressure hydrocephalus (walking difficulty, memory change and bladder symptoms)
  • Chronic subdural haematoma
  • Brain tumours causing memory, personality or balance changes
  • Balance problems where a structural cause is suspected
  • Parkinson's disease and movement disorders where surgical assessment is relevant
  • Memory and thinking problems where imaging shows a possible structural cause

How it is assessed

Assessment includes a history, often with input from family members, a neurological examination and brain imaging such as MRI or CT. For suspected normal pressure hydrocephalus, further tests may be arranged to see whether draining fluid is likely to help.

Treatment options

Depending on the cause, options may include observation, medicines, a shunt for normal pressure hydrocephalus, drainage of a chronic subdural haematoma, or surgery for a tumour. Medical management of Parkinson's disease and dementia remains multidisciplinary and is led by neurology or geriatric medicine where appropriate.

Go to A&E or call 995 instead if

  • You have a sudden, severe headache, the worst you have ever had
  • You have a seizure for the first time, or a seizure that does not stop
  • You develop new weakness, numbness or drooping of the face, arm or leg
  • You have new difficulty speaking or understanding speech
  • You have sudden loss of vision, double vision or loss of balance
  • You become confused or very drowsy

Before you book

Common questions

The doctor explains the cost of any medicines, tests or procedures before going ahead.