Differential Diagnosis
- Single most likely diagnosis
- E) Trigeminal neuralgia: The patient's sharp, "electrical" pain over the right side of her face, particularly with decreased sensation over the right premolar area of the superior dental arch and prolongation in the right V2 on somatosensory evoked potentials, strongly suggests trigeminal neuralgia. The condition is also more common in patients with multiple sclerosis.
- Other Likely diagnoses
- C) Occipital neuralgia: Although less likely, occipital neuralgia could present with sharp pain, but it typically involves the back of the head rather than the face. However, given the patient's symptoms and medical history, it's a consideration.
- B) Hemifacial spasm: This condition involves involuntary muscle contractions on one side of the face, which could potentially cause pain. However, the primary complaint here is pain rather than muscle spasms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None of the options directly point to a condition that would be immediately deadly if missed, given the information provided. However, it's crucial to consider other potential causes of facial pain that could have serious underlying conditions, such as:
- Stroke or Transient Ischemic Attack (TIA): Although the CT angiography shows irregular coursing of the basilar artery, there's no direct indication of an acute stroke. Nonetheless, any new onset of neurological symptoms warrants careful consideration of vascular events.
- None of the options directly point to a condition that would be immediately deadly if missed, given the information provided. However, it's crucial to consider other potential causes of facial pain that could have serious underlying conditions, such as:
- Rare diagnoses
- A) Cluster headache: While cluster headaches can cause severe, unilateral pain, they are typically accompanied by other symptoms such as conjunctival injection, lacrimation, and nasal congestion, which are not mentioned in the scenario.
- D) Temporomandibular joint dysfunction: This condition can cause facial pain but is usually associated with jaw dysfunction and pain, which is not the primary complaint here.