Doctors Lounge - Neurology Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Neurology Topics
Question: Periodic left side facial paresthesia
|Guest12349 - Sun Dec 02, 2007 10:14 am||
Hi I am a 33 y/o male, About 1 ½ years ago I had some periodic tension headaches that lasted about 1-2 weeks. At this time I would get shooting paint in the scalp that lasted 2 second – 3 minutes. I went to my doctor which concluded that I had a contracted neck muscle (Left shoulder was and still is about 1 inch higher than the right one). He gave me some magnesium supplements and preformed some kind of neck adjustment (Low impact). About a week later I started having paresthesia (no numbness) in my left cheek. I went to the ER and had a MRI scan preformed the following day. There was nothing on MRI scan and a neurologic examination found nothing.
Following the above I have been going to the doctor regularly as the paresthesia has been periodic ever since. There have been periods ever the paresthesia disappeared for 1-2 months completely but mostly it is there in attack like episodes 2-4 times a day lasting 30 minutes-3 hours and now from just above the eyes to the chin on the left side. With the paresthesia attacks I often feel complete drained from energy and are completely unable to concentrate on anything during the attack and 20-30 minutes after. I have never woken during the night with this paresthesia and it is almost never there the first 30 minutes after getting out of bed.
About a month ago I went to a neurologist who did a complete evaluation again which was normal except from an unexplained and according to him unheard of delayed/sticking sensation when testing the sensation with a cotton pin on the left side of the face. On left side the sensation was the same as on the right side when the pin was moving over the face but sensation on left side stayed for 30 minutes after the test (Not a moving sensation but more like the cotton pin was touching the skin or spinning sensation over the complete path it took). This sensation was also present at the time when I went to the ER but at that time the examining doctor did not react on it. The neurologic told there was nothing he could do and I just have to wait and see what happens next.
Has anyone heard about this kind of sensation?
My doctor fund some kind of issue with protein levels (Serum protein electrophoresis test?) in my blood and thought there was a kidney problem. But a 24 hours urine collection and tests (including a Bence Jones) on that and more blood work was all negative. He now wants to wait ½ year and do the tests again.
I saw a dentist about the issues because my doctor felt it could be related to a tooth issue and the dentist did find a raised wisdom tooth and said that could give some issues but probably not this. The tooth has pulled but it did not help.
Before all of this I had migraine with aura (expanding zigzag lines in the vision and fatigue after an attack) most of the time without headaches 1-4 times a year from I was about 26 -29 y/o and then about two years with nothing before this.
Could the above symptoms be the same migraine but just with paresthesia instead of vision zigzag lines and a lot more frequent? (The neurologist I saw and my doctor say no)
Could this be related to the shoulders being asymmetric in height? (Again the neurologist I saw and my doctor say no)
Could this be related to some kind of nerve compression when sitting (As I do not have it that often when I am not working or sitting down for long periods and when sleeping/laying down)? (Again the neurologist I saw and my doctor say no)
Can the fatigue I am experiencing when having these attacks be related to some kind of sensory overload or does that mean it must be a brain issue? (No one I have seen could give me a clear answer on that)
Could this be TIA’s 2-4 times a day over months?
Any idea on what to test next or concrete deceases?
Any ideas from qualified people are appreciated as this is beginning to ruin my life and apparently the doctors I have access to do not know how to precede.
Thanks of any replies.
|Dr. Chan Lowe - Fri Feb 01, 2008 1:12 am||
Parasthesias are often due to a nerve issue. They can occur with migraines but the rapidness of the episodes tends to argue against them. Similarly, seizures would not be expected to come and go this quickly (with rare exception).
I wonder if you may have some swelling or inflammation causing the trigeminal nerve to be compressed or irritated somehow. This could potentially cause your symptoms. The trigeminal nerve provides sensation to the face and is divided into three parts. The top portion basically supplies the forehead, the middle portion supplies the cheek and the lower portion supplies the chin/jawline area.
There is a condition called trigeminal neuralgia that more typically causes pain but may potentially be able to cause these parasthesias.
I would recommend you continue to follow up with your neurologist for further evaluation and testing to help figure this out.
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.