Sharp

Nervous System & Special Senses


Step 1: View Clinicals

A 34 year old man presents with multiple episodes of intense, sharp, right-sided facial pain which last for about a minute and occur around ten times a day; these first started 2 months ago.


The pain is worst over the nasolabial groove and is precipitated by brushing his teeth, shaving, washing his face, eating, and talking.


His medical and surgical histories are unremarkable.


Step 2: Order Relevant Investigations

1. MRI + MRA Brain

check

The brain and intracranial vasculature appear normal.

2. Nerve Biopsy

clear

You realize that a nerve biopsy is probably not indicated here.

3. Lumbar Puncture

clear

The CSF analysis is within normal parameters.

4. Liver Function Tests

check

Total protein: 5.1 g/dL (6.3 - 7.9)

AST: 56 U/L (8 - 48)

ALT: 78 U/L (7 - 55)

PT: 10.2 s (9.5 - 13.8)

Bilirubin: 0.9 mg/dl (0.1 - 1.0)

Step 3: Select Appropriate Management

1. Carbamazepine

check

2. Sumatriptan

clear

3. Surgery

clear

4. Valacyclovir

clear