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A 54 year-old man with severe left facial pain
A 54 year-old man complains of severe left facial pain for six months. The pain comes in “jolts” involving
the left cheek. He discovered that shaving often brought on the pain, which was so severe that he grew
a beard in order to avoid triggering it. The pain also occurs without obvious precipitant; lately is has been
happening in a “series of shocks.” He saw an otolaryngologist, who told him his sinuses and ears were
completely normal. The worry that heʼll have the pain, which he rates as 10/10 in severity, has made him
depressed and anxious.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? Include doses for 1
medication you might prescribe for this patient along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about his condition and about any proposed
therapy
A 54 year-old man complains of severe left facial pain for six months. The pain comes in “jolts” involving
the left cheek. He discovered that shaving often brought on the pain, which was so severe that he grew
a beard in order to avoid triggering it. The pain also occurs without obvious precipitant; lately is has been
happening in a “series of shocks.” He saw an otolaryngologist, who told him his sinuses and ears were
completely normal. The worry that heʼll have the pain, which he rates as 10/10 in severity, has made him
depressed and anxious.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you treat this patient? Include doses for 1
medication you might prescribe for this patient along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about his condition and about any proposed
therapy. A 54 year-old man with severe left facial pain.