Sudden Facial Pain

[LucidResq]

Aunt calls for her 11 year old niece who she is babysitting. Chief complaint-sudden onset eye and nose pain. The child is screaming and crying in pain and having difficulty opening her eyes completely. No signs of injury. She states she was sitting around watching TV when it started. No known exposures, trauma, etc etc. Family and child are clueless to cause. No medical history. No known allergies besides mild seasonal. She ate fried chicken for dinner hour and a half ago.

What is your assessment? What are your differentials?

Sorry I don't have a lot more... this is a 911 call I took and I don't want to make up stuff to fill in the gaps.

 

[Cup of Joe]

increased intraocular pressure? From what I have no idea, but thats my guess.

 

[Aidey]

Which eye, and what part of the nose? Why can't she open her eyes? Any sensitivity to light?

 

[depri]

Taking a wild stab at it: Seeing as she has mild seasonal allergies, maybe her allergies are just in overdrive and causing some bad sinus pressure, or maybe a possible onset of sinusitis (but that still wouldn't explain her having trouble opening her eyes)...

...which instead would make me consider a possible sudden onset of a food allergy; but then the 1 1/2hr time frame from eating to onset might knock the food allergy out.

Like I said, just taking a wild stab at it.

 

[Meursault]

Standard vitals, good set of lung sounds, closely examine head and neck (nuchal rigidity?), check eye movement and pupils, tap sinuses for tenderness, check cranial nerves if I'd ever gotten around to learning them.


Stream of consciousness DDx: meningitis, ruptured AVM, chicken-related oropharynx injuries, My First Migraine.

 

[jkuzak]

Cranial Nerves

Cranial Nerves acronyms:

"O,O,O, To Touch Amy's Great Vagina And Hips."


Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glossopharyngeal, Accessory, Hypoglossal.


And to remember which are sensory, motor or both is:

"Some Say Marry Money But My Brother Says Big Boobs Matter Most."

Sensory, Sensory, Motor, Motor, Both, Motor, Both, Sensory, Both, Both, Motor, Motor.*

* these correspond to the other acronym. IE: Olfactory is sensory, optic is sensory, etc.

 

[McGoo]

Jumping straight to diagnosis/conclusion, maybe something akin to Bell's palsy?

 

[samiam]

Cranial Nerves acronyms:

"O,O,O, To Touch Amy's Great Vagina And Hips."


Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glossopharyngeal, Accessory, Hypoglossal.


.

Wouldent ""O,O,O, To Touch Amy's Ferocious, Amazingly Great Vagina And Hips." work better?


You missed a few in there

 

[McGoo]

Wouldent ""O,O,O, To Touch Amy's Ferocious, Amazingly Great Vagina And Hips." work better?


You missed a few in there

I have heard Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen. Stuck in my head fairly well.

 

[samiam]

I have heard Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen. Stuck in my head fairly well.

YESSSS!!! I knew I learned one but i could not come up with it.

The one I learned was Oh Oh Oh To Touch And Feel A Girls Vagina Ah

 

[bigbaldguy]

We get this all the time on the plane in young children on descent from altitude but obviously a rapid change in pressure and plugged up sinuses probably aren't the cause here. Could be some kind of nerve issue involving a impacted tooth? She's about the right age for some molars to be coming in. Some of the nerves in the jaw can cause referred pain to the eye,ear,nose.