TY - JOUR
T1 - Diagnosing Trigeminal Neuralgia Based on Clinical Diagnostic Reasoning in an Elderly Patient
AU - Usuda, Sho
AU - Muraoka, Wataru
AU - Asoda, Seiji
AU - Horie, Nobuyuki
AU - Nakagawa, Taneaki
AU - Ouchi, Takehito
N1 - Publisher Copyright:
© 2021 Tokyo Dental College Society.
PY - 2021
Y1 - 2021
N2 - When pain adversely affects a patient’s activities its diagnosis needs to be fast and accurate to allow effective treatment to be commenced as soon as possible. Difficulties may be found in achieving this, however, in elderly patients with age-associated cognitive decline, as they may not be capable of properly understanding or recalling their symptoms. The present case concerns a 77-year-old woman who presented with the chief complaint of pain in the right mandible persisting throughout the day, and severe enough to necessitate her lying down in bed all day long. The use of open-ended questions followed by a structured interview focused on pain with closed-ended questions revealed that she experienced paroxysms of pain throughout the day and that she was afraid of its occurrence. Based on these findings, the diagnosis was trigeminal neuralgia. Carbamazepine decreased the pain with no side effects. The patient continued taking carbamazepine for 3 months, during which time she was closely monitored for adverse reactions. No side effects, such as drowsiness or dizziness, were observed, however, and the pain subsided completely with no recurrence, even after cessation of carbamazepine.
AB - When pain adversely affects a patient’s activities its diagnosis needs to be fast and accurate to allow effective treatment to be commenced as soon as possible. Difficulties may be found in achieving this, however, in elderly patients with age-associated cognitive decline, as they may not be capable of properly understanding or recalling their symptoms. The present case concerns a 77-year-old woman who presented with the chief complaint of pain in the right mandible persisting throughout the day, and severe enough to necessitate her lying down in bed all day long. The use of open-ended questions followed by a structured interview focused on pain with closed-ended questions revealed that she experienced paroxysms of pain throughout the day and that she was afraid of its occurrence. Based on these findings, the diagnosis was trigeminal neuralgia. Carbamazepine decreased the pain with no side effects. The patient continued taking carbamazepine for 3 months, during which time she was closely monitored for adverse reactions. No side effects, such as drowsiness or dizziness, were observed, however, and the pain subsided completely with no recurrence, even after cessation of carbamazepine.
KW - Age-associated cognitive decline
KW - Clinical diagnostic reasoning
KW - Pain
KW - Trigeminal neuralgia
UR - http://www.scopus.com/inward/record.url?scp=85122546069&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122546069&partnerID=8YFLogxK
U2 - 10.2209/tdcpublication.2021-0012
DO - 10.2209/tdcpublication.2021-0012
M3 - Article
C2 - 34776477
AN - SCOPUS:85122546069
SN - 0040-8891
VL - 62
SP - 253
EP - 260
JO - Bulletin of Tokyo Dental College
JF - Bulletin of Tokyo Dental College
IS - 4
ER -