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Pattern recognition · Neuroanatomy · INBDE Patient Cases

Neuro Syndromes INBDE Patient Cases

By Dr. Isaac Sun, DDS

9 ADA INBDE-format patient cases on neuro syndromes. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

9 patient cases45 linked questionsADA INBDE formatFull distractor explanations

Nine ADA INBDE-format patient cases on the neurological conditions a dentist recognizes and manages: facial pain, facial weakness, stroke and seizure emergencies, and neuromuscular disease. Topics include trigeminal neuralgia versus a toothache, Bell's palsy versus a central (stroke) facial palsy, giant cell (temporal) arteritis with jaw claudication, myasthenia gravis with fatigable chewing and bulbar weakness, managing a seizure in the dental chair with phenytoin gingival overgrowth, dental care for a stroke survivor on anticoagulation, distinguishing vasovagal syncope from a seizure, transient ischemic attack, and burning mouth syndrome.

Case Coverage Map
What each case is testing
Electric facial jolts mistaken for a bad tooth:
Trigeminal neuralgia vs odontogenic pain, light-touch trigger, carbamazepine, don't treat a healthy tooth.
New one-sided facial droop in the dental office:
Bell's palsy (LMN, forehead involved) vs central palsy (forehead spared), eye protection, chorda tympani/stapedius.
Jaw fatigue on chewing with a new temple headache:
Giant cell (temporal) arteritis, jaw claudication, vision-threatening emergency, vs TMD.
Drooping lids and jaw fatigue worse through the day:
Myasthenia gravis, fatigable bulbar/masticatory weakness, aspiration, drug cautions, short morning visits.
A seizure during a dental appointment:
Seizure management (protect, time, when to call EMS), phenytoin gingival overgrowth and the classic drug trio.
Dental care for a stroke survivor with weakness:
Post-stroke aspiration and hygiene, anticoagulation management, vigilance for a new stroke.
A brief loss of consciousness in the chair:
Syncope vs seizure (prodrome/recovery vs tongue biting/postictal), supine-legs-up, prevention.
Transient facial droop and arm weakness that resolved:
Transient ischemic attack, FAST, carotid source, urgent referral despite recovery.
A constant burning tongue with a normal-looking mouth:
Burning mouth syndrome, diagnosis of exclusion (B12/iron, candidiasis, xerostomia), neuropathic management.
Patient case: Electric facial jolts mistaken for a bad tooth
0 of 5 answered, 0 correct
Patient
Female, 61 years old
Chief Complaint
"I get sudden electric-shock jolts in my cheek when I touch my face, brush, or chew; I think it's this upper tooth."
Background and/or Patient History
  • Weeks of brief, severe, stabbing right cheek pain
  • Attacks last seconds and are triggered by light touch, brushing, or chewing
  • Completely pain-free between attacks
  • Two dentists found no dental cause; a previous filling did not help
Allergies
NKDA
Medications
  • None
Current Findings
  • A light-touch trigger zone near the right nasolabial fold sets off the pain
  • Suspect teeth are vital, non-carious, and normal on radiographs
  • No swelling; pain follows the V2 distribution
  1. Question 1
    Moderate
    This brief, shock-like, trigger-evoked facial pain is most consistent with:
  2. Question 2
    Moderate
    The feature that best separates her pain from a toothache is:
  3. Question 3
    Easy
    Which cranial nerve carries this pain?
  4. Question 4
    Moderate
    Why should you not extract or root-canal the suspect tooth?
  5. Question 5
    Moderate
    First-line management of trigeminal neuralgia is:

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Patient case: New one-sided facial droop presenting to the dental office
0 of 5 answered, 0 correct
Patient
Female, 39 years old
Chief Complaint
"The whole right side of my face drooped overnight, I can't raise my eyebrow or close my eye, and my smile is crooked."
Background and/or Patient History
  • Symptoms developed over a day; recent viral upper respiratory illness
  • Cannot wrinkle the forehead or close the eye on the right
  • No limb weakness, no slurred speech
  • Some decreased taste on the front of the tongue and sound sensitivity
Allergies
NKDA
Medications
  • None
Current Findings
  • Complete right facial weakness including the forehead (lower motor neuron pattern)
  • Incomplete eye closure on the right
  • No limb or speech deficits
  1. Question 1
    Moderate
    Forehead involvement indicates the lesion is:
  2. Question 2
    Easy
    The most likely diagnosis is:
  3. Question 3
    Hard
    Which additional Bell's palsy feature reflects involvement of CN VII branches proximal to the stylomastoid foramen?
  4. Question 4
    Moderate
    The most important protective measure for this patient is:
  5. Question 5
    Moderate
    If she instead had forehead sparing plus arm weakness and slurred speech, the correct action would be to:

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Patient case: Jaw fatigue on chewing with a new temple headache
0 of 5 answered, 0 correct
Patient
Female, 74 years old
Chief Complaint
"My jaw aches and tires partway through a meal so I have to stop chewing, and I have a new headache over my temple."
Background and/or Patient History
  • New one-sided temporal headache for two weeks
  • Jaw muscles fatigue and ache during chewing, easing with rest (jaw claudication)
  • Scalp tenderness when combing hair; aching shoulders
  • One brief episode of blurred vision
Allergies
NKDA
Medications
  • None
Current Findings
  • Tender, firm temporal artery
  • Jaw claudication reproduced by sustained chewing
  • Age over 50 with markedly elevated ESR and CRP
  1. Question 1
    Moderate
    Jaw claudication, a temporal headache, and scalp tenderness in an older adult suggest:
  2. Question 2
    Hard
    Why does her jaw tire and ache during chewing?
  3. Question 3
    Moderate
    The most feared complication if this goes untreated is:
  4. Question 4
    Moderate
    The appropriate response to suspected giant cell arteritis is:
  5. Question 5
    Moderate
    Jaw claudication differs from a TMJ disorder in that it:

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Patient case: Drooping eyelids and jaw fatigue that worsen through the day
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
"My eyelids droop and I see double by evening, and my jaw gets too tired to finish chewing."
Background and/or Patient History
  • Fluctuating weakness that worsens with use and improves with rest
  • Ptosis and double vision worse late in the day
  • Jaw tires while chewing; occasional trouble swallowing
  • Diagnosed with myasthenia gravis
Allergies
NKDA
Medications
  • Pyridostigmine
  • Low-dose prednisone
Current Findings
  • Fatigable ptosis worsening on sustained upgaze
  • Jaw and tongue fatigue with repetitive movement
  • Speech becomes weaker and more nasal with prolonged talking
  1. Question 1
    Moderate
    Weakness that worsens with use and improves with rest is characteristic of:
  2. Question 2
    Moderate
    The underlying defect in myasthenia gravis is:
  3. Question 3
    Moderate
    Her jaw fatigue and swallowing weakness create which dental concern?
  4. Question 4
    Easy
    The best appointment planning for her is:
  5. Question 5
    Hard
    Before prescribing for her, an important caution is that:

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Patient case: A seizure during a dental appointment
0 of 5 answered, 0 correct
Patient
Male, 28 years old
Chief Complaint
Mid-appointment he becomes unresponsive with generalized stiffening and jerking; he has epilepsy on phenytoin.
Background and/or Patient History
  • Known epilepsy, on long-term phenytoin
  • Reports he missed his morning dose
  • Sudden generalized tonic-clonic activity in the chair
  • Marked gingival overgrowth noted on exam before the event
Allergies
NKDA
Medications
  • Phenytoin
Current Findings
  • Generalized tonic-clonic seizure, then a drowsy postictal state
  • Generalized gingival enlargement
  • Recovers spontaneously after a couple of minutes
  1. Question 1
    Moderate
    The immediate management of a seizure in the dental chair is to:
  2. Question 2
    Moderate
    You should activate EMS if:
  3. Question 3
    Moderate
    His marked gingival overgrowth is most likely caused by:
  4. Question 4
    Moderate
    Which other drug classes also cause gingival overgrowth?
  5. Question 5
    Moderate
    Management of his gingival overgrowth centers on:

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Patient case: Dental care for a stroke survivor with one-sided weakness
0 of 5 answered, 0 correct
Patient
Male, 69 years old
Chief Complaint
"Since my stroke a year ago my right side is weak, I sometimes choke on liquids, and I can't brush well."
Background and/or Patient History
  • Ischemic stroke a year ago with residual right hemiparesis
  • Dysphagia with occasional coughing on thin liquids
  • Difficulty brushing and flossing with the weak hand
  • On an anticoagulant for stroke prevention
Allergies
NKDA
Medications
  • Apixaban
  • Atorvastatin
  • Lisinopril
Current Findings
  • Right-sided weakness affecting hand dexterity
  • Plaque accumulation, worse on the weak side
  • History of coughing/aspiration on thin liquids
  1. Question 1
    Moderate
    His dysphagia most directly raises the risk of:
  2. Question 2
    Easy
    His right hemiparesis affects oral health mainly by:
  3. Question 3
    Moderate
    Food pocketing on his weak side occurs because of:
  4. Question 4
    Hard
    Regarding his anticoagulant for a simple extraction, the usual approach is to:
  5. Question 5
    Moderate
    If he developed a sudden new facial droop and slurred speech at a visit, you should:

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Patient case: A brief loss of consciousness in the dental chair
0 of 5 answered, 0 correct
Patient
Male, 35 years old
Chief Complaint
He felt nauseated and lightheaded, then briefly lost consciousness in the chair after an injection, coming to within seconds.
Background and/or Patient History
  • Anxious about the injection; warm, busy operatory
  • Pre-event nausea, sweating, and graying vision
  • Brief loss of consciousness while sitting upright
  • Rapid, clear recovery when laid back, with no confusion afterward
Allergies
NKDA
Medications
  • None
Current Findings
  • Pallor and sweating before the event
  • Brief loss of consciousness with quick, clear recovery
  • No tongue biting, no incontinence, no prolonged confusion
  1. Question 1
    Moderate
    This event is most consistent with:
  2. Question 2
    Moderate
    Which features point to syncope rather than a seizure?
  3. Question 3
    Moderate
    Which finding would instead make you suspect a seizure?
  4. Question 4
    Easy
    The immediate management of his faint is to:
  5. Question 5
    Moderate
    To prevent recurrence at the next visit, you should:

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Patient case: Transient facial droop and arm weakness that resolved
0 of 5 answered, 0 correct
Patient
Male, 71 years old
Chief Complaint
"During my cleaning my face drooped and my arm went weak for about ten minutes, then it all went back to normal."
Background and/or Patient History
  • Hypertension, hyperlipidemia, and a carotid bruit noted previously
  • Right facial droop and right arm weakness that fully resolved within 15 minutes
  • Brief slurred speech during the episode
  • Now neurologically back to baseline
Allergies
NKDA
Medications
  • Aspirin 81 mg daily
  • Atorvastatin
Current Findings
  • Transient focal deficit, now resolved
  • Vascular risk factors and a carotid bruit
  • Normal current neurologic exam
  1. Question 1
    Easy
    A focal neurologic deficit that fully resolves within minutes to an hour is a:
  2. Question 2
    Moderate
    Because the deficit resolved, the correct action is to:
  3. Question 3
    Easy
    The bedside screen for stroke/TIA recognition is summarized as:
  4. Question 4
    Moderate
    His carotid bruit suggests a likely mechanism of:
  5. Question 5
    Moderate
    The key teaching point for the dental team is that:

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Patient case: A constant burning tongue with a normal-looking mouth
0 of 5 answered, 0 correct
Patient
Female, 62 years old, postmenopausal
Chief Complaint
"My tongue and lips burn all day like they're scalded, but I'm told my mouth looks normal."
Background and/or Patient History
  • Months of a daily burning sensation of the tongue and lips
  • Burning often eases while eating and worsens through the day
  • No visible lesions; taste sometimes altered and the mouth feels dry
  • Otherwise healthy; screening labs are being checked
Allergies
NKDA
Medications
  • None
Current Findings
  • Normal oral mucosa with no ulcers, candidiasis, or lesions
  • Burning of the tongue and lips without a visible cause
  • Reported dry-mouth sensation and intermittent taste change
  1. Question 1
    Moderate
    Chronic oral burning with a normal-looking mouth and no identifiable cause is:
  2. Question 2
    Moderate
    Primary burning mouth syndrome is fundamentally:
  3. Question 3
    Moderate
    Which finding would point AWAY from primary BMS toward a treatable secondary cause?
  4. Question 4
    Moderate
    Burning that improves while eating is characteristic of:
  5. Question 5
    Moderate
    Appropriate management of primary BMS includes:

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Keep studying
Neuro Syndromes core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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