Numbness on face, loss of balance, headache. ARTERIAL DISSECTION?

Resolved Question:

I have been having some concerning symptoms lately and I would really appreciate your help. One day I felt a numbness on the left side of my face, it included my forehead, ear region and upper cheek. This numbness has been coming and going for the past 5 days and sometimes the side of my cheek and ear will become very hot. I worry that it may be related to a an arterial dissection as I crack my own neck at least once or twice a day but I am not sure. Sometimes I also feel a very full pinpoint ache in the left side of my forehead, or a very dull headache in my temples. Occasionally I also feel an acute loss of balance, as though I feel like I am leaning to the left. I have had no loss or affect in my vision, speech, or coordination beside the balance issue. I have been checking my blood pressure while I feel these symptoms, and that is normal. I had normal results for an EKG in June, and I do not feel neck pain.


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hi,
Thanks for your query at DoctorSpring.com
I have noted your symptoms and they warrant further investigations. Episodic neurological symptoms as in your case can be either caused by seizures of TIAs (transient ischemic attacks). In seizures, there are abnormal electrical discharges from the brain. In TIA, the blood supply to a part of brain gets reduced for a short time.
Investigations would include EEG, and MRI/MR angiogram of brain.
Treatment can be planned after the investigations.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Doctor Kumar, I have had a CT scan done, blood work, and a chest x-ray done, ECG, all of those came back clean. The other day I had an MRI on my brain as well as an angiogram of my arteries done, and they found nothing abnormal and no signs of arterial dissection. What else could be causing these symptoms, or what other tests should I look in to? Sometimes the numbness comes and goes, but right now I am sitting in a chair and I am noticing pressure in my left temple, and the upper corner of my left eye feels just slightly heavy. I can smile, squint, and open my eyes equally fine though.
I have attached some screenshots of my MRI. Thank you for your help!


Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back.
Other than TIA and seizures, there are no other possible causes for your symptoms.
The screenshots of MRI you have sent are all normal.


Patient replied :

So if all of my tests are normal and TIA and seizures are rulesd out by them, then what does that mean? What about migraine or nerve damage?


Expert:  Dr. Sudhir Kumar replied 2 Days.

Thank you for getting back.
TIA and seizures can not be ruled out on the basis of normal MRI/MR angiogram and EEG. This means, test may be normal and you could still have TIA or seizures. A neurologist has to make the final diagnosis based on the nature of symptoms.
Regarding migraine, the symptoms are not suggestive of the same.
Nerve damage would be seen on the MRI.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

Doctor Kumar, I have finally seen a neurologist and he ruled out seizeure and TIA. He sited potentially a type of complex migraine and stress/anxiety. I am not sure how convinced I am with this diagnosis, he was very dismissive of my concerns as soon as he saw my MRI and EEG results. My symtpoms have improved over the past 4 weeks and I only occassionally feel an acute level of numbness in the left side of my head and slight weakness in my left arm and leg. I just feel like the left side of my body is slightly weak and I am not quite the same as I was before all of this started happening. I agree with doctors that stress and anxiety play a factor but I am in the US Navy and I have experienced unrivaled levels of stress and never had a problem before, I feel it is quite normal to be anxious when the left side of your body goes weak. Do you have any other ideas or suggestions I can take to my GP to try and find the root of the cause for my symptoms? Any sort of guidance would be greatly appreciated, it has been really hard to convince doctors that something is wrong as soon as they see my test results are normal.


Expert:  Dr. Sudhir Kumar replied 1 Day.

Thank you for getting back.
I am surprised that your doctor excluded TIA and seizures based on normal MRI and EEG. In fact, in half the proven cases of TIA and seizure, MRI and EEG come out as normal. It is more the clinical correlation and examination findings that help in making a correct diagnosis.
Migraine would be a distant third possibility, as in some rare cases of complicated migraine, numbness and weakness could occur.
Stress/anxiety alone is unlikely to cause these symptoms. I agree, a person with these symptoms can have added anxiety.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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