Differential Diagnosis for 80-Year-Old Female with New Onset Intermittent Sharpshooting Temporal Pain
- Single Most Likely Diagnosis
- Trigeminal Neuralgia: This condition is characterized by sudden, severe, sharpshooting pain around the eyes, lips, and nose mainly due to abnormal blood vessels pressing on the trigeminal nerve in the head. The patient's age and the nature of the pain (sharp, shooting, and intermittent) make this a highly plausible diagnosis.
- Other Likely Diagnoses
- Temporomandibular Joint (TMJ) Disorder: Pain in the TMJ can radiate to the face and mouth, and while it's more common in younger populations, it can occur at any age, especially if there's a history of dental work or jaw issues.
- Dental Issues (e.g., Abscess, Impaction): Dental problems can cause severe, sharp pain that may radiate to different parts of the face and mouth. Given the patient's age, dental issues are a common concern.
- Migraine or Cluster Headaches: Although less common in new onset at this age, certain types of headaches can cause sharp, shooting pain that may involve the face.
- Do Not Miss Diagnoses
- Giant Cell Arteritis: This is an inflammatory disease of blood vessels that can cause severe headaches, jaw claudication, and visual disturbances. It's crucial to consider this diagnosis due to the risk of blindness if not promptly treated.
- Stroke or Transient Ischemic Attack (TIA): While less likely to present with sharpshooting pain, any new onset of neurological symptoms, especially in an elderly patient, warrants consideration of a stroke or TIA.
- Multiple Sclerosis: Although rare, the onset of MS can occur at any age, and it may present with a wide range of neurological symptoms, including pain.
- Rare Diagnoses
- Raeder’s Syndrome: A rare condition characterized by a combination of symptoms including facial pain, ptosis (drooping eyelid), and decreased sweating on one side of the face.
- Tolosa-Hunt Syndrome: A rare disorder characterized by severe and unilateral headaches with extraocular palsies, which could potentially cause facial pain.
- Sinusitis: While more commonly associated with pressure and dull pain, acute sinusitis could potentially cause sharp pain, especially if it involves the sphenoid sinus.