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A middle-aged woman presents with a complaint of frequent, brief episodes of intense, shooting left-sided jaw pain. She has experienced these attacks for several years, but they had previously been relatively rare. She says that episodes are sometimes brought on by eating but can occur without an apparent stimulus. The patient’s history is remarkable for herpes zoster infection. What are the most important differential diagnoses?

December 27, 2020 6:47 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, mandibular osteomyelitis and temporal arteritis.

A 28 years old white female presents with ascending numbness and weakness in both feet, slightly symmetrically, over a period of 2 weeks. Patient history reveals a 3-week history of unilateral hemibody paresthesias during finals week in college 6 years ago. Since then, she reports occasionally having some tingling on that side if she is overly tired, stressed, or hot. What potential sequelae do you need to be concerned about?

December 27, 2020 6:46 am Published by

Permanent paresthesias ( hemiplegia), cognitive impairment and depression

A 28 years old white female presents with ascending numbness and weakness in both feet, slightly symmetrically, over a period of 2 weeks. Patient history reveals a 3-week history of unilateral hemibody paresthesias during finals week in college 6 years ago. Since then, she reports occasionally having some tingling on that side if she is overly tired, stressed, or hot. What are the most important differential diagnoses?

December 27, 2020 6:45 am Published by

Of the relevant differential diagnoses, it is important to rule out vitamin B12 deficiency, acute disseminated encephalomyelitis and syphilis.

A 40 years old presents with left-sided facial paralysis, which began as left ear and facial pain a day earlier. She reports slight numbness and loss of taste on the left side of her tongue and finds her hearing in her left ear to be unusually sensitive. She has difficulty keeping liquids in her mouth, smiling, or closing her eyes. On physical exam, the left nasolabial fold is absent, and the left corner of her mouth droops. On the left side, she cannot voluntarily raise her eyebrow, close her eyelid, elevate her mouth into a smile, snarl, or pucker her lips. The rest of the history and physical exam are normal. What potential sequelae do you need to be concerned about?

December 27, 2020 6:43 am Published by

Corneal abrasion and ulceration and complications of corticosteroid use, such as aseptic avascular necrosis or psychological disturbance

A 40 years old presents with left-sided facial paralysis, which began as left ear and facial pain a day earlier. She reports slight numbness and loss of taste on the left side of her tongue and finds her hearing in her left ear to be unusually sensitive. She has difficulty keeping liquids in her mouth, smiling, or closing her eyes. On physical exam, the left nasolabial fold is absent, and the left corner of her mouth droops. On the left side, she cannot voluntarily raise her eyebrow, close her eyelid, elevate her mouth into a smile, snarl, or pucker her lips. The rest of the history and physical exam are normal. What are the most important differential diagnoses?

December 27, 2020 6:43 am Published by

Of the relevant differential diagnoses, it is important to rule out brain tumor, stroke, transient ischemic attack, and meningitis.

A 40 years old presents with left-sided facial paralysis, which began as left ear and facial pain a day earlier. She reports slight numbness and loss of taste on the left side of her tongue and finds her hearing in her left ear to be unusually sensitive. She has difficulty keeping liquids in her mouth, smiling, or closing her eyes. On physical exam, the left nasolabial fold is absent, and the left corner of her mouth droops. On the left side, she cannot voluntarily raise her eyebrow, close her eyelid, elevate her mouth into a smile, snarl, or pucker her lips. The rest of the history and physical exam are normal. What is the most likely diagnosis?

December 27, 2020 6:42 am Published by

Bell’s palsy

A 37 years old woman presents with a 12-year history of episodic headaches. She experiences these 4 times a week, typically beginning at the end of a workday. The pain is generalized and described as similar to wearing a tight band around her head. The headaches are bothersome, but not disabling, and she denies any nausea or vomiting. She is slightly sensitive to noise but has no photophobia. Pain during her attacks typically responds to ibuprofen. Examination reveals tenderness of her scalp and both trapezius muscles. What potential sequelae do you need to be concerned about?

December 27, 2020 6:41 am Published by

Impaired social and occupational functioning

A 37 years old woman presents with a 12-year history of episodic headaches. She experiences these 4 times a week, typically beginning at the end of a workday. The pain is generalized and described as similar to wearing a tight band around her head. The headaches are bothersome, but not disabling, and she denies any nausea or vomiting. She is slightly sensitive to noise but has no photophobia. Pain during her attacks typically responds to ibuprofen. Examination reveals tenderness of her scalp and both trapezius muscles. What are the most important differential diagnoses?

December 27, 2020 6:40 am Published by

Of the relevant differential diagnoses, it is important to rule out pituitary or brain tumor, increased intracranial pressure, meningeal irritation,... View Article