Recurrent spontaneously reduced unilateral temporomandibular joint dislocation masquerading as a transient ischemic attack

Abstract

Abstract Transient ischemia attack (TIA) is a daily challenge for emergency department (ED) doctors, particularly in patients who cannot express themselves clearly. Without a patient's precise subjective description, the doctor's clinical judgment may be influenced by the statements of bystanders. Symptoms might mimic focal neurological symptoms and lead to a misdiagnosis of a TIA. We report a 79-year-old woman with recurrent spontaneously reduced unilateral temporomandibular joint (TMJ) dislocation masquerading as a TIA. She experienced unilateral facial droop, deviation of the angle of the mouth, and difficulty speaking three times while eating. Because the patient's family and both the ED doctor and neurologist focused on TIA from the onset, TMJ dislocation was overlooked in the interpretation of the head computed tomography (CT) scan. When another episode occurred after the patient yawned while at the ED, unilateral TMJ dislocation was considered and confirmed. In conclusion, when patients present purely facial neurological signs after mouth opening, unilateral TMJ dislocation should be excluded first.