Differential Diagnosis for 80-year-old with Left-sided Pain
Single most likely diagnosis
- Temporal Arteritis (Giant Cell Arteritis): This condition is a common cause of unilateral headache in the elderly, often described as aching or throbbing and localized to the temporal region, which could radiate to the cheekbone area. The absence of fever, cough, cold, or trauma history, along with normal eye movements and vision, does not rule out this diagnosis, as these symptoms can be variable.
Other Likely diagnoses
- Trigeminal Neuralgia: Characterized by sudden, severe, shock-like or stabbing pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. The pain is typically unilateral and can be triggered by factors such as touch or wind, which might not be explicitly mentioned but could be considered given the location of the pain.
- Dental Issues: Toothaches or dental infections can cause referred pain to the cheekbone area. Although the question does not mention dental issues, it's a common enough problem that could present with these symptoms, especially in an elderly population where dental health might be compromised.
- Sinusitis: While the question mentions no coughs or colds, sinusitis can sometimes present without these typical upper respiratory symptoms, especially in the elderly. The pain above the eyebrow and on the cheekbone could be consistent with frontal or maxillary sinusitis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke or Transient Ischemic Attack (TIA): Although the pain description does not classically suggest a stroke, and eye movements and vision are normal, it's crucial to consider stroke in any new onset of neurological symptoms, especially in an elderly patient. The absence of typical stroke symptoms does not rule out this diagnosis entirely.
- Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that could present with facial pain, although it typically includes other symptoms such as fever, proptosis, and cranial nerve deficits, which are not mentioned here.
Rare diagnoses
- Raeder's Syndrome: A rare condition characterized by a combination of symptoms including unilateral facial pain, ptosis (drooping eyelid), and miosis (constricted pupil), without other neurological deficits. It's a rare diagnosis but could be considered given the unilateral nature of the pain.
- Cluster Headaches: Although these are typically more severe and include autonomic features like nasal congestion or lacrimation, they could be considered in the differential for unilateral head pain, especially if the pain is severe and occurs in clusters or cycles.