Nerves

The Mysterious Episodes of Mary: A Case Study on Neuroanatomy

Episode 1

Mary Lazarro, a 44-year-old mother of two, made an appointment with her physician after experiencing a prolonged episode of numbness in her chin and lower lip. Two days prior to her appointment, she felt a prickling sensation like “pins and needles” at the right corner of her mouth. The sensation extended to her lower lip and chin. The examination revealed only a superficial hypoesthesia of the chin and lower lip (numb chin syndrome). There was no clinical evidence of palpable regional lymph nodes or other systemic or neurologic abnormalities. Her physician scheduled her for a CT scan of the affected region. These tests showed no abnormalities in the jaw, neck, or pharynx. The numbness and hypoesthesia spontaneously disappeared gradually over a few weeks.

Episode 2

Four months later, while eating dinner with her family, Mary felt a stabbing pain in her upper jaw and teeth that radiated out to the side of her nose. Over the next several days, she experienced several more episodes of this intense pain. A visit to the dentist revealed no abnormalities and she was referred to her physician for an evaluation. Prior to her appointment, she noticed that the symptoms were subsiding as they had previously. Her physician scheduled an appointment for a complete neurological exam the following week.

Episode 3

Three nights prior to her scheduled visit to the neurologist, Mary stopped at an intersection and experienced intense double vision when looking to the right to check for traffic. The double vision was less intense when looking forward, and her vision when looking left was unaffected. Her husband noticed that her right eye appeared to be turned slightly inward when she looked straight ahead. A day later, Mary noticed that the vision in her left eye started to blur. The neurologist later suggested that the two visual problems she was experiencing were related. The double vision when looking...