Pt cases

Question 1

Known as nervus intermedius neuralgia, Ramsay
Hunt’s syndrome
Painful disturbance of the sensory portion of the
Facial nerve - CN VII
Causes lancinating pain in the middle ear and the
auditory canal
Treatment: Methyl prednisone (10mg) start with
80mg dose, then taper by 10 mg every 3 days until
20 mg dose. Maintain patient on 20mg for 14 days
then taper off.

Answer 1

Geniculate neuralgia

Question 2

 A rare condition that is caused by inflammation of
the stylohyoid ligament.
Symptoms: sore throat, dysphagia, otalgia,
glossodynia, headache or vague pain in the neck
 Pain may occur with swallowing, talking, chewing,
turning the head to the contralateral side, yawning
 Usually unilateral, constant, deep, throbbing or
aching
 Exam: includes palpation of the stylohyoid area to
attempt to reproduce pain & turning head to side
 Radiograph: reveals elongated stylohyoid process
 Refer to Ear, Nose & Throat (ENT) specialist

Answer 2

Eagle’s syndrome

Question 3

 Elongation or calcification of the
stylohyoid ligament along with a recent
hx of neck trauma (i.e. tonsillectomy)
may cause nerve impingement: CN V, VII,
IX, X, or XII (all pass in close proximity to
the styloid process)
 Symptoms: vague pain in the neck may result from
mechanical impingement of carotid artery
 Internal carotid artery impingement may cause
symptoms of eye pain, temporal headache,
migraine, vertigo, visual changes, aphasia, and
syncope
 Most patients are asymptomatic & no tx required
 Treatment: steroid or lidocaine injections into the
tonsillar fossa initially then amputation.

Answer 3

Eagle’s syndrome

Question 4

A. Facial and/or oral pain fulfilling criteria B and C
B. Recurring daily for >2 h per day for >3 mo
C. Pain has both of the following characteristics:
* 1. poorly localized, and not following distribution of a
peripheral nerve
* 2. dull, aching or nagging quality
D. Clinical neurological examination is normal
E. Dental cause excluded by appropriate investigations
F. Not better accounted for by another ICHD-3 diagnosis

Answer 4

Persistent idiopathic facial pain

Question 5

What nerve innervates masticatory muscles?

Answer 5

Trigeminal

Question 6

What is another disorder that should be in differential for TN? Demyelination of CNS

Answer 6

Multiple sclerosis

Question 7

INterview q’s for ______:
Ask patient if he/she is experiencing:
Tooth/gum pain in > 2 quadrants
Dizziness, loss of balance, blurred vision
Numbness of 1 side of face in a young person,
sometimes following local anesthesia for dental work
Tingling/numbness in hands/feet
Weakness in hands, arms, legs
Difficulty with walking

Answer 7

Multiple sclerosis

Question 8

Prevalence: Female: male is 2:1 in Chronic
form; no gender preference for Episodic
No family hx
Maximal pain is experienced in the ocular,
temporal, maxillary, and frontal regions.
In rare occasions, toothache or otalgia is
the presenting symptom.
Pain is throbbing, boring, pulsat

Answer 8

Paroxysmal hemicrania

Question 9

Multiple attacks of severe unilateral orbital,
supraorbital &/or temporal pain
Duration: 2 to 45 minutes
Frequency: > 3 attacks per day & up to 30
Associated Features (at least 1):
Conjunctival injection, lacrimation, nasal congestion,
rhinorrhea, ptosis, eyelid edema
Intervals between bouts may last months - years
Treatment: Indomethacin (absolute response)

Answer 9

Paroxysmal hemicrania

Question 10

Tooth pain without obvious pathology
and of unknown etiology( formerly
known as atypical odontalgia).
Treatment:
1. Membrane stabilizers (i.e.
Neurontin)
2. Anti-depressants

Answer 10

Persistent idiopathic facial pain