A Toothache That Was a Stroke: Acute Right Parietal Infarction Presenting As Isolated Left-Sided Odontogenic-Like...

Pain as a presenting symptom of acute ischemic stroke is uncommon and may delay diagnosis when typical focal neurological deficits are absent. A 52-year-old man with arterial hypertension and a history of tobacco and alcohol use presented to the ED with sudden, severe left-sided toothache-like pain perceived as arising from the teeth. He had no recent dental procedure, trauma, fever, or systemic infectious symptoms. An oral and dental examination revealed no gingival swelling, facial cellulitis, dental abscess, percussion tenderness, or other convincing odontogenic cause. Neurological examination revealed no facial weakness, dysarthria, aphasia, hemiparesis, limb ataxia, visual field deficit, cranial nerve abnormality, or definite objective sensory loss. Non-contrast CT of the brain excluded intracranial hemorrhage. Brain MRI with diffusion-weighted imaging demonstrated an acute right parietal cortico-subcortical ischemic lesion. The patient was treated with aspirin for secondary stroke prevention, and pregabalin was prescribed for the symptomatic management of presumed central neuropathic pain. The odontogenic-like pain improved substantially during follow-up. This case demonstrates that acute parietal ischemic stroke may present as isolated contralateral toothache-like pain. Acute, severe dental or orofacial pain without a clear odontogenic explanation should prompt consideration of a neurological cause, particularly in patients with vascular risk factors. Diffusion-weighted MRI may be necessary when clinical suspicion of acute ischemic stroke persists despite an otherwise unremarkable neurological examination.