TONGUE PAIN
TONGUE PAIN: Excerpt from Differential Diagnosis in Primary Care
Examination of the tongue is a time-honored important diagnostic aid,
but in my experience, it is unusual for patients to present with pain in the
tongue. Nevertheless, there is a plethora of causes. The mnemonic
VINDICATE lends itself best to prompting the recall of these
causes.
V—Vascular disorders suggest pernicious
and iron deficiency anemia.
I—Inflammation recalls Vincent stomatitis, herpes simplex,
tuberculosis, and syphilis. The referred pain from gingivitis and abscessed
teeth should also be considered here.
N—Neoplasms remind one that carcinoma of the tongue often
presents with pain.
D—Degenerative and deficiency diseases remind one of
pellagra and other avitaminoses.
I—Intoxication and idiopathic disorders call to mind tobacco, plumbism, mercurialism, and glossopharyngeal or
trigeminal neuralgia.
C—Congenital anomalies of the tongue are rare.
A—Allergic and autoimmune diseases, in contrast, suggest
dermatomyositis and angioneurotic edema.
T—Trauma suggests the numerous times we bite our tongues and may
prompt a search for epilepsy when a patient presents with syncope.
E—Endocrine disorders remind one of
hypothyroidism.
Approach to the Diagnosis
The approach to the diagnosis includes a CBC, sedimentation rate, serum
B12 and folic acid levels, serum ferritin, serology, tuberculin test,
and perhaps biopsy of the lesion. A trial of vitamin therapy may be
indicated.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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