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Face Numbness
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Face Numbness

For the past four years the left side of my face has been numb.  The numbness is like I went to the dentist and it never wore off.  It goes from the top of my face to the bottom of it and is split from the center of my nose to the back of my ear and does include my tongue.  I spent over a year going to a variety of doctors and specialists having many different tests done.  It is not Bells Palsy because I have complete movement in my face muscles.  They did find empty sella from my MRI but have told me that is not the cause.  The basic explanation that I am givin is that it is just a fluke.  I guess my question is should I take that as an answer or should I be pushing for more of an explanation.
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Avatar_n_tn
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   Facial numbness can be localized to the trigeminal nerve (cranial nerve V) anywhere from the peripheral branches to its origin in the Pons (middle part of the brainstem).  I do not know the extent or results of the tests that you have had so far, but I will give you some ideas of conditions that can cause "hard to diagnose" facial numbness and some tests to look for these conditions.
   Some infections/diseases such as lyme, sarcoid, lymphoma, and herpes zoster can infect/infiltrate the trigeminal nerve and cause your symptoms.  For this an MRI with Contrast with attention to CN V may show enhancement of the the nerve.  Also a lumbar puncture with cytology will be helpful.
   Another possibility is pressure is being placed on the nerve.  Increased intracranial pressure has been implicated in causing facial numbness (usually causes double vision (CN VI problem) but can also affect CN V).  This is most commonly seen in benign intracranial hypertension (BIH)[also called pseudotumor cerebri] in patients with normal MRIs.  The "empty sella" is caused by protrusion of the lining of the brain into the pituitary area, and is often incidental, but can also signify increased intracranial pressure.  For this I would recommend that you get a lumbar punture with opening pressure.
   Arnold-Chairi malformation (should have shown up on your MRI) can also cause unilateral facial numbness (by kinking the brainstem).
   Migraine headaches can sometimes cause focal neurologic symptoms (that are intermittent) without headaches (called migraine equivalents). There is no test for this, but a trial on a migraine preventative medication, such as elavil, may get rid of the numbness if this is the cause.
   Additional tests that may be helpful include testing your corneal reflex and jaw muscles (also CN V).  An electro-physiological test of your blink response, may also help (more sensitive for CN V dysfunction).
   Finally, stress/depression can sometimes cause a somatiform disorder, which is a diagnosis of exclusion only, but can improve with appropriate psychiatric help.
   If your facial numbness has been stable for the past 4 years, that is good news, but if your symptoms progress to involve visual loss, double vision, dizziness, nausea/vomiting, headache then you should seek attention immeadiately.
I hope this has been helpful.
3 Comments
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Avatar_f_tn
If this is neurological, you may have a single nerve neuropathy, which is very rare.  It sounds like they've done all the right tests and haven't found anything life-threatening.  The good thing is that your symptoms are not getting worse.  It is possible that the nerve was damaged by some conspicuous manner (whether by a small stroke or by trauma or infection) but there is very little you can do to clarify that.  I would just try to enjoy your health and otherwise and get routine check ups done.
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Avatar_n_tn
In 4/2002, had first presentation of numbness to point I truly felt I was having a stroke. By the time I arrived to the ER, I had complete numbness in my head, and most of the left-side of my body.  I struggled to talk when I was at triage.  My speech was slurred, my thoughts had slowed, I had tunnel vision, my left eye socket was pounding.  What was happening?

Over weekend @ UCI Medical Center in CA. Long story short, after spending 6+ hours in ER nothing was dianoised.  Had a CT scan, an MRI, blood work.  NOTHING! Thank heavens all tests came back negative, but no real explanations.  Any clues?

Here's what sent me to the ER:  The tip of my tongue had been numb for almost 5 days, the lower left quadrant of my face was totally numb now and my left hand up to my elbow was going numb as well.  I was on vacation and so I called my neuro.  He advised me to go to an ER and have an MRI done.

Of course, the ER staff told me I would have to have blood drawn, give a urine sample and eventually I would go for a CT scan.  I told the attending doctor that my neuro knew what was happening because I had just spoken to him moments before arriving. I also told her that he advised having an MRI done to check brain activity while it was presenting.

Still, they kept me for what seemed a full day.  Labs came back "normal" as did the CT scan and by now my head felt as if it would explode.  About 2 hours after that news, I was wheeled back to the basement to have the MRI finally done.  That too came back "normal."

What now?  When I was diagnoised with "migraines" I was on the verge of turning 40.  My mom and 3 of 4 siblings had also been diagnoised with migraines.  

This probably has no relevance but I am left-handed.  My migraines always present with numbness on my left side mostly.  Fortunately, I don't throw up or get naseaus...BUT what is going on? Occurences are not frequent until I have an "episode" and then they vary in length and frequency. Any possible answers? I would truly appreciate any feedback.
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