Undetected Brain Tumor

It is always wise for the healthcare provider to maintain a broad view of the patient when trying to evaluate and understand their problem(s).  Clinicians in all specialties must avoid ‘tunnel vision’ during the evaluation process.  Collecting a careful history of symptoms is always important and can, at times, be critical as shown in this example where the essential information needed was obtained by using a screening and assessment tool, the TMJ Scale, as part of a thorough evaluation process.

A women with a history of ovarian cancer had pain in her ears and soreness in her face and TM joint, mainly on the left side.  The pain was not helped by Tylenol or Ibuprofen.  She thought she might have an ear infection but neither her family doctor nor an ENT referral found any problem.  She was then referred for suspected “TMJ” to a dental  specialist in that field.

The dentist’s clinical exam only revealed a minor TMJ problem.  To be thorough, the dentist asked the patient to take the TMJ Scale test, in part to conduct a thorough evaluation of TMJ symptoms and also to make sure nothing else was being missed.  The test results did confirm only a “borderline” TMJ problem.  However, the part of the test that screens for Non-TMJ problems was also somewhat elevated.  Again, to be thorough, this finding led to ordering an MRI.  The MRI revealed a brain tumor called a meningioma on the left side.  Treatment for the minor TMJ problem was put off while the patient was referred to a neurologist for further evaluation. 

This is an example of how using a screening tool like the TMJ Scale to collect and thoroughly evaluate a patient’s symptoms can help lead to an accurate diagnosis. (Published in the Journal of Craniomandibular Practice, 1991)