Chapter 6. Related Neurology and Neurosurgery
A 35-year-old woman presents with the primary complaint of “sinus pain.” She states that she has had severe pain around her eye that is associated with tearing, nasal congestion, and rhinorrhea; all of her symptoms are on the right side. Upon further questioning, she reveals that she has had these symptoms throughout most of her adult life and says that these symptoms are quite persistent for 2 to 3 weeks and then relapse; she is symptom free for 1 to 2 months before the symptoms return. She believes most of her symptoms occur with changes in the weather and she does not complain of associated nausea, vomiting, or photophobia. What is her diagnosis?
A 45-year-old man presents to your clinic with left eye pain. Upon examination he has no extraocular movement from his left eye. Other than a frozen eye and a slightly dilated pupil that does not normally constrict to light, he has a normal neurologic examination. An MRI shows abnormal enhancement of the anterior cavernous sinus, superior orbital fissure, and orbital apex without signs of mass effect or of a dural tail extending posteriorly or laterally. What is the diagnosis?
A 55-year-old man presents to clinic with a 1-year history of facial pain. He states that he has sharp, lancinating pain radiating down his mandible that is exacerbating by shaving, brushing his teeth, and by cool air touching his face. You correctly diagnose him with trigeminal neuralgia. What is the first-line treatment for trigeminal neuralgia?
A. Microvascular decompression
A 29-year-old man presents with a history of a seizure disorder. He states that his seizures are associated with lip-smacking and odd sensations over his chest wall that lead to unconsciousness and generalized tonic-clonic activity. What is the seizure disorder that affects this patient?
C. Temporal lobe seizures