Differential Diagnosis for a Patient with Trigeminal Neuralgia, Hematuria, and Elevated Creatine Kinase (CK)

Single Most Likely Diagnosis

• Multiple Sclerosis (MS): This condition can cause trigeminal neuralgia due to demyelination in the central nervous system. Hematuria could be unrelated or due to a separate condition, and an elevated CK could be from muscle damage unrelated to the primary neurological condition. However, MS itself doesn't typically cause elevated CK levels directly.

Other Likely Diagnoses

• Sarcoidosis: This autoimmune disease can cause neurological symptoms, including trigeminal neuralgia, and can also affect the kidneys, leading to hematuria. Elevated CK levels could be due to muscle involvement.
• Vasculitis (e.g., Granulomatosis with Polyangiitis): Vasculitis can cause a wide range of symptoms, including neurological issues like trigeminal neuralgia, renal involvement leading to hematuria, and muscle inflammation resulting in elevated CK levels.
• Amyotrophic Lateral Sclerosis (ALS): While ALS primarily affects motor neurons, some patients may experience pain or discomfort that could be mistaken for trigeminal neuralgia. Elevated CK levels can occur due to muscle damage, and hematuria could be an unrelated finding.

Do Not Miss Diagnoses

• Cancer (e.g., Multiple Myeloma, Lymphoma): Certain cancers can cause trigeminal neuralgia (e.g., through compression or infiltration), hematuria (through renal involvement), and elevated CK levels (through muscle metastasis or paraneoplastic syndromes). Missing a diagnosis of cancer could be fatal.
• Vascular Malformations or Aneurysms: Although less likely, vascular abnormalities could cause trigeminal neuralgia and, if they involve the renal vessels, could also lead to hematuria. Elevated CK might not be directly related but could occur due to associated conditions.
• Infections (e.g., Neurosyphilis, Lyme Disease): Certain infections can cause a wide range of neurological symptoms, including trigeminal neuralgia, and could potentially lead to renal symptoms and elevated CK levels through various mechanisms.

Rare Diagnoses

• Mitochondrial Myopathies: These are a group of disorders that affect the mitochondria, leading to muscle weakness and elevated CK levels. Some forms could potentially cause neurological symptoms mimicking trigeminal neuralgia, and renal involvement could lead to hematuria.
• Neurodegenerative Disorders with Systemic Involvement: Rare conditions like Huntington's disease or certain spinocerebellar ataxias could potentially cause a combination of neurological symptoms, including those mimicking trigeminal neuralgia, along with systemic symptoms like elevated CK and hematuria, although this would be highly unusual.