Burning and Loss of Dexterity on Right Sdie

[krobe51465]

I am a 37Y active male.  Last year my left vertebral artery was dissected after a collission during a soccer match.  At the time my presenting symptoms were Horner's Syndrome, ptosis, loss of balance, mismatched pupils, and heat sensations on the right side of my body.  My CT Scans and MRI/MRA's were normal but an arteriogram found a complete occlusion of the VA above the PICA.  I was in the hospital for 3 1/2 weeks on heperin and then released on coumadin.  Approx. 2 weeks after discharge I began to experience stroke like symptoms so I was re-admitted to the hospital.  MRI/MRA's again were normal.  Another arteriogram showed that the clot was gone.  I was discharged on aspirin.

Now, approx. 10 months later, I still experience burning on the right side of my body - it seems to be intensified by physical activity in the heat.  I also feel like I've lost some dexterity in my right hand and I frequently "drop" (fail to write) the first digit/letter of numbers or words I am trying to write.  I am thinking of the letter but it doesn't make it to the paper.

I have been on neurontin for @ 9 months - currently at 2,400mg/day. Last week I had a MRI of head and neck and a Somato Evoke Response Test.  All results were normal.  

Any clues as to what could be causing these issues?  Suggestions for other tests?  I would like to know the cause and not just medicate over symptoms that I don't understand.  Apologies for the length.  Thanks for your time.

K.J. Roberts

[CCF-Neuro-M.D.-JT]

It sounds like you had what's called a Wallenberg's syndrome or PICA (name of an artery), which is one of the well known stroke syndromes in which the vertebral artery or less commonly the posterior inferior cerebellar artery (PICA) is occluded.  This leads to a stroke in the part of the brainstem that has nerve fibers to the eye/eyelid producing a Horners', cerebellum producing incoordination and dizziness, and loss of pain and temperature sensation on the face the side of the arterial blood clot and other side of the body. Since your artery was dissected on the left, the symptoms of abnormal pain and temp sensation on the right side of the body fit with the syndrome nd unfortunately can be difficult to treat due to the permanent nerve damage. There's no cure, but treatment with medications such as neurontin, elavil, tegretol, trileptal, or dilantin may be of benefit. Try adding the elavil and see if that helps. Otherwise, there;s a cream called capsaicin cream which you can get at the drug store made of chili peppers that apparently "burns out" your pain nerve fibers, but hurts like the dickens when you put it on. Finally, consider a pain clinic for more aggressive treatments if all else fails. Good luck