Trigeminal neuralgia

I've just seen Rose who has trigeminal neuralgia.

She presented classically with left sided facial pains. She described toothache even though she wears dentures, marked pains across her forehead, and pain across her jaw.

All pain stopped at the midline.

The diagnosis today was easy.

But looking back through Rose's notes, I realised that she came to see me back in November with an odd sensation of pins and needles in her mouth. She had just had some new dentures fitted by her dentist, and it had been assumed at that time that this was the cause of her symptoms.

In fact a lot of medical problems can present like this. Initially the symptoms can be vague and non specific, but as they develop the actual diagnosis becomes more and more obvious. The patient may wonder why the doctor did not make the diagnosis earlier. Delay in diagnosis is a common cause of complaint against GPs. Hindsight is a wonderful thing.