MKSAP: 36-year-old woman with facial pain

A 36-year-old woman is evaluated for a 1-week history of recurrent episodes of facial pain that are 1 to 3 seconds in duration and occur spontaneously dozens of times throughout the day. The pain is sharp, severe, and located in the right infraorbital area. During this same period, she has developed worsening bilateral lower extremity weakness and urinary incontinence. The patient has an 18-year history of relapsing-remitting multiple sclerosis treated with interferon beta-1a; she also takes baclofen to control spasticity. She has had no nausea, photophobia, phonophobia, nasal congestion, nasal drainage, or ocular/visual changes. On physical examination, blood pressure is 100/64 mm Hg and pulse rate is 80/min. Moderate bilateral lower extremity weakness and hyperreflexia are noted. Sensory spinal cord level for pain and temperature is T6. Plantar responses are extensor bilaterally. Internuclear ophthalmoplegia is noted, but other findings from an examination of the cranial nerves are unremarkable. Results of laboratory studies, including a comprehensive metabolic profile, a complete blood count, and urinalysis, are normal. Which of the following is the most likely cause of the facial pain? A. Chronic paroxysmal hemicrania B. Herpes zoster C. Primary stabbing headache D. Trigeminal neuralgia Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Neurology Source Type: blogs