Lynn Sparks: A 26-Year-Old Sales Associate With Sharp, Stabbing Pain With Swallowing

Lynn Sparks

“It hurts every time I swallow and every time I turn my head to the left,” complained Lynn Sparks. Lynn had been my patient for a couple of years. She was a senior sales associate at our local Dillard's. I had seen Lynn before for an uncomplicated urinary tract infection. Lynn had called the office earlier in the week and asked if we could work her in because she thought she had an ear infection. She recognized that she didn’t have the usual fever that goes along with ear infections but decided to keep the appointment because her pain was not getting any better. I asked Lynn if she had experienced any fever or chills, and she shook her head no.

I asked Lynn if she had ever had anything like this before, and she shook her head no. “So, no fever or chills. Did you choke on anything or accidently swallow a bone?” Again, she shook her head no. l suggested that we look her over to figure out what was wrong, so we could make it better.

I asked Lynn to point with one finger where it hurts the most. Lynn pointed to her right anterior neck. “It starts right here, and when I swallow or turn my head to the left, I get this electric shock up into my jaw and ear.”

“Is there any numbness?” I asked. Lynn replied that she hadn’t noticed any. “You know, Doctor, this pain is making it hard to get any rest because if I swallow or roll over at night, I get the pain.”

“Are you having any visual problems, or is there anything else that I need to know about?” I asked. Lynn replied, “Nothing else. Other than this pain, I feel fine.” Lynn’s last menstrual period was 1 week ago.

On physical examination, Lynn was afebrile and her respirations were 16. Her pulse was 74 and regular with a blood pressure of 110/68. Palpation of her cranium revealed no mass or other abnormality. Her fundoscopic examination was normal. A careful examination of the ears bilaterally were completely normal. Examination of her throat was normal, with evidence of a previous tonsillectomy. Her dentition was normal, with no impacted wisdom teeth. Her cardiopulmonary examination was normal. Her abdominal examination revealed no abnormal mass or organomegaly. There was no costovertebral angle (CVA) tenderness. There was no peripheral edema. Palpation over the right anterolateral neck at the level of the cricothyroid cartilage elicited a shocklike pain that radiated from the point of palpation to her contralateral ear and jaw. When I had Lynn turn her head to the left as far as she could, she again experienced the pain: nuchal ridge to the top of her head on the left. Her neurologic examination was otherwise within normal limits. There were no pathologic reflexes.

Key Clinical Points—What’s Important and What’s Not