Differential Diagnosis for Sudden Pain while Brushing Teeth with Abnormal Head and Neck MRI
- Single most likely diagnosis:
- Trigeminal Neuralgia: This condition is characterized by sudden, severe, shock-like or stabbing pain in parts of the face, which can be triggered by routine activities such as brushing teeth. The pain is typically brief but can be very intense. An abnormal head and neck MRI might show compression of the trigeminal nerve, which is a common cause of this condition.
- Other Likely diagnoses:
- Multiple Sclerosis (MS): MS can cause a wide range of neurological symptoms, including pain, due to demyelination in the central nervous system. An abnormal MRI could indicate lesions consistent with MS, which might explain the pain and other neurological symptoms.
- Eagle Syndrome: This condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause facial pain, especially in the area of the jaw and throat. The pain can be sharp and stabbing, similar to what is described.
- Do Not Miss diagnoses:
- Glossopharyngeal Neuralgia: Although less common than trigeminal neuralgia, glossopharyngeal neuralgia can cause severe pain in the throat and base of the tongue, which might radiate to the ear. It's a condition that could be deadly if missed due to potential complications like syncope or cardiac issues triggered by the pain.
- Brainstem or Cerebellar Tumor: Any tumor in the brainstem or cerebellum could potentially cause facial pain, among other neurological symptoms, depending on its location and the structures it compresses. Missing such a diagnosis could have severe consequences.
- Rare diagnoses:
- Motor Neuron Disease (MND): While MND primarily affects motor neurons, some forms can have associated pain or sensory symptoms. However, it would be less likely to present primarily with brief, severe pain triggered by brushing teeth.
- Raeder Syndrome: A rare condition characterized by a combination of facial pain, miosis, and ptosis, typically due to a lesion in the middle cranial fossa affecting the trigeminal nerve and sympathetic fibers. It's a rare diagnosis but could explain some of the symptoms if there are accompanying signs of sympathetic dysfunction.