Turning Heads: Neck Pain And Facial Numbness In An Adolescent

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Turning Heads: Neck Pain And Facial Numbness In An Adolescent - Page #1

Author: Blake Barton, MD Senior Editor: Kevin Gray, MD Editor: Greta Bires, MD Patient Presentation: A previously healthy 16-year-old male presented to the sports medicine clinic with two months of neck pain progressing to facial numbness. History: There was no inciting event, and he described the pain as dull, intermittent, and slowly worsening. The pain was mild and located in the upper neck, radiating towards the side. There were no aggravating factors. He mentioned numbness at the jawline on both sides that had developed over recent weeks. He visited the pediatrician where cervical radiographs were reported as normal, and from there he was referred to the sports medicine clinic. He had attempted to rest from recreational sports and had taken non-steroidal anti-inflammatories without improvement. He denied any headache, blurred vision, swelling, or skin changes. His past medical history included attention deficit hyperactivity disorder. He took no medications and had no allergies. His family and social history were unremarkable. Physical Exam: General: well appearing male, well-developed, no apparent distress HEENT: no cervical adenopathy or tenderness, pupils equal round and reactive to light, extraocular eye movements intact, moist mucus membranes, no visible deformities or palpable masses of neck Musculoskeletal: gait normal, neck supple with full range of motion, tenderness to palpation of upper cervical spine and paraspinal muscles, Spurling test and Lhermitte’s test negative, normal muscle strength. Neurologic: cranial nerves II-XII intact, paresthesia bilaterally along the lower cheek and mandible, upper extremity reflexes normal. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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