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.
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
The brain and intracranial vasculature appear normal.
2. Nerve Biopsy
You realize that a nerve biopsy is probably not indicated here.
3. Lumbar Puncture
The CSF analysis is within normal parameters.
4. Liver Function Tests
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)
1. MRI + MRA Brain
The brain and intracranial vasculature appear normal.
2. Nerve Biopsy
You realize that a nerve biopsy is probably not indicated here.
3. Lumbar Puncture
The CSF analysis is within normal parameters.
4. Liver Function Tests
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
2. Sumatriptan
3. Surgery
4. Valacyclovir
1. Carbamazepine
2. Sumatriptan
3. Surgery
4. Valacyclovir