Neurology Expert Forum
Facial Numbness, RA
About This Forum:

This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Facial Numbness, RA

I am a 43 year old female who has had RA since 1993. There were a couple of years when the RA was not well controlled and it affected the joint where the head connects to the neck and the joint in the spine right at the top of the shoulders.

I'm including the full history, so I don't leave out something important.

In the fall of 1998 I herniated a disk left side L5-S1. It was bad. Surgery went well - relieved intense pain. During physical therapy, I was doing situps in pool. Following this, I got buttocks,right leg numbness and pain shooting down the the right leg. Another MRI revealed nothing. X-rays nothing. Just live with it. I still have this.

In May 1999, I started experiencing numbness in little finger of left hand, then little finger of right, then ring, etc. Cervical MRI showed herniation at c5-6 - not touching spinal column. x-rays normal. When in the shower, I would tilt my head back and I could feel numbness come beneath both shoulder blades.

In July 1999, I turned my head far at an intersection when driving. It hurt, but with RA sometimes things hurt. About 1 hour later my face started to go totally numb. Mostly left side.
I also had heart palpitations. They seemed to come when I layed down. Heart palpitations were recorded/verified on device by primary. The heart palpitations have gone away now. They lasted a couple months.

I saw a neurologist. He ordered a brain scan, eeg. These were normal. When I got up from the brain scan, I had significant double vision that did not receed for about 45 minutes. I had one other episode of double vision when I layed down. I got up right away; it only lasted about 5 minutes. Diagnosis: migraine. When I got the migraine diagnosis, I had been numb for 4 weeks. I asked isn't this a little long for a migraine to last without any headache. He said yes. But, there is nothing seriously wrong with you. I was dismissed.

I figured if it was migraine, it wouldn't hurt to move my head. I tilted my head to look up, and the numbness in my face came on stronger for a few days.  I stopped moving my head at this point.

In addition to the numbess, I get the feeling that someone is pressing on my throat. This can sometimes occur with every step.
I walk very gently. If I realign my head, I can get this to lessen/go away.

My head felt loose. Acceleration and deceleration in the car would cause my neck to crack and numbness come on. If I tripped over something numbness would come on strong and the pressure in the throat, too. It would last for a few days.

Rheumatologist suggested a cervical collar. I now wear that when I drive. When I put on the cervical collar, the facial numbness tends to receed, but a burning sensation tends to come at the base of my neck - near shoulders. This happens repeatably about 75% of time.

I have felt - pin pricks (a couple seconds in tongue), my teeth are numb, the roof of my mouth is numb. I have felt pain up the back of my head. I have felt sensations on the top of my head. Just a small patch. I have felt pain out to ear cartilage (not inside the ear). I have had pain go up back of head. Also my scalp in middle is sometimes numb. I have had a few headaches. One or two took all day to go away. Others receeded the second I layed down. The numbness comes and goes. It seems to be related to movement. Primarily external pressure - vehicle movement, gravity when I bend, someone touches head. My head was numb for two days after pressure of putting on leads for evoke potentials test. If I carefully move my head, I seem to be ok. Although at one point, I would tilt my head very slight to look down in a file cabinet and it would be very difficult. Could only do for 2-3 minutes. I can't quite articulate the exact difficulty - not pain, not severe numbness-just strong discomfort.

I had my teeth cleaned in Nov. 1999. They would press on my teeth and I would feel it in my throat / face. At one point, my neck was sore. I rubbed the back of my neck right side where the tendon is and felt pressure on the front of my throat.

With all this, the migraine diagnosis just didn't click for me. I sought another neurologist. She did an MRA, evoke potentials, bloodwork for mini-strokes - all normal. Because the MRI of c-spine and c-spine x-rays were taken before the numbness in the face started; I begged to get them done again. MRI showed progression of the C5-6 problem - maybe instability - get x-rays. First x-rays showed no change. Rheumatologist tried to help. He said it didn't look like they took extra shots of high level c-spine in MRI. He said the flexion/extension did not look correctly taken. More x-rays of c-spine. They showed mild atlantoaxial instability. Went to neurosurgeon. He said this is common with RA nothing to worry about - its only about 4 mm. He thought hand numbness was related to carpul tunnel. He ordered  upper EMG. It was normal. Neurosurgeon said neurologically I look pretty good.

This numbness gets better and worse many times per day. I'm usually pretty good in the morning when I get up. When I get dressed - it comes on. I don't know if it is brushing teeth, washing hair or what. But by the time I'm done, my face is numb (inside my mouth too). It has been on the left, right and middle of face/head. Sometimes it is just the middle. Neurosurgeon said this seemed neurologically impossible. After that, I verified sometimes it is just in the middle. Perhaps it comes from sides and receeds from sides.

I can make this come and go, by adjusting my position. I had one event after taking a long car ride where every time I stood up my face went extremely numb - I ran right back to bed. This happened when I needed the x-rays. I called the neurologist, I was getting scared. She said go get the x-rays. I got the x-rays and actually seemed to feel a little better, I was afraid I would get worse/pass out. The rad. report said it seemed to realign on flexion and extension.

Until this point my only strategy has been wear the cervical collar and try not to move my neck much. I'm looking for something more effective.  

I feel very good in a pool with water up to my chin. All symptoms seem to receed.

Other info: ANA negative, RF positive, thyroid ok, B12 ok in 1998.
Meds: Enbrel started early 1999 - has my RA 90%+ under control-many joints have realigned with reduced inflammation. Celebrex, minocin,premarin/provera.
We tried to reduce minocin. RA got a little worse, numbness got a little better. Increased minocin; RA got a little better, numbness got a little worse. Coincidence? Possible inverse relation?
A couple weeks ago, I had dizziness/lightheadedness during mid day for a few days. This was when we were adjusting meds - minocin and premarin up. Related? Minocin is now up, premarin back down to .3.

Since this started 1 year ago, I do seem slightly better. I would say my head has tightened up a little. If I trip, I do not get numb for days, just an hour or two. I can do a little more without the numbness coming on - but, I can't do anything compared to others my age.

Here are my specific questions, any other advice would be appreciated. Currently my strategy is to see if I survive a teeth cleaning. If so, hang in there. If not, make an appointment with you. Everyone says they just don't know. Only one to give advice at all is rheumatologist. He says I've seen some pretty good people - Cleveland Clinic or Johns Hopkins - if I want to pursue. What do you think pursue or live with it?

I feel like something must be pushing on something when I move and laying perfectly aligned for an MRI does not allow it to be captured. Is there a test that might capture it?  If so does the benefit outweigh the risks?

Does this sound like a structural problem to you? or disease process?

Because the double vision occurred during the brain MRI, might that picture have captured something that they didn't look for that might help explain this?

Would you recommend I see a psychiatrist? It is hard for me to believe this is in my head. I feel like I think my head is loose and the Drs. think a screw is loose. My sister says that I am sensitive to things wrong. I complained about my joints 5 years before they could confirm a diagnosis of RA. It came and went. Palindrom rheumatism I believe they called it.

Any thoughts you have would be greatly appreciated. What do you think I should do/consider doing.

Thank you so much for helping all of us on this board. Is there a way for individuals to contribute so more people can be helped.














Related Discussions
Avatar_n_tn
Dear Judy:

The problems with your head and face are likely not coming from a lower cervical cord problem.  The symptoms you are experiencing in your shoulders and arms and hands could be, but not your face, eyes and head.  It may be that your upper cervical cord is undergoing changes but the MRI should have shown something.  However, unless your looking for something in the upper cervicals one might miss things.  The nerves to the eyes that would cause double vision or diplopia are located in the brain and therefore not apart of your cervical cord problem, I am not sure what to say about this.  The first impression is that your RA is inducing changes in your spinal cord at various levels and this is producing symptoms.  Unfortunately, there is nothing much to do about this besides what your doing at present.  The collar sounds like a good thing if it helps you drive safely and without pain.  The best thing would be to stay in close contact with your neurologist and follow the RA and symptoms along with imaging of your cervical cord.  A second opinion is often helpful as a new set of eyes and mind looking at your problem may reveal something overlooked.  It might also help your emotional state knowing that your diagnosis is what you thought it was.

Sorry, without being able to examine you and visualize the MRI it is difficult at best to give you precise information.

Sincerely,

CCF Neuro MD
14 Comments
Blank
Avatar_n_tn
One other thing that might be important. The rheumatologist said when looking at the neck x-rays. This does not look like a really bad neck. You do not see erosions (shot through the mouth), like he sees in some people with severe disease and long history of prednisone usage. I have only had 2 methylprednisolone dose packs in my life both for l5/s1 herniation. I have taken ridaura, sulfisalazine in past - more than 1 year ago. Also, bone density showed worst place 92% of what it should be.



Blank
Avatar_n_tn
HI,

I to have facial numbness, with stress and worry it got worse and my entire face went numb, the forhead and both checks and eyelids.  Then it turned to burning.  I had a complete workup and mri of brain normal, so its not a leson in the brain causing this.  MS has been pretty much ruled out and im on anti-depressants, a new one seems to be working?  I still entertain the though that its not anxiety, but I take one day at a time and as long as im feeling good I try not to worry.  I sure hope you find an answer and I look forward to seeing what the Dr says.  Good luck to you.
Blank
Avatar_n_tn
Thank you so much for your reply and spending your evenings helping us in need of advice.

If I decided to come to the Cleveland Clinic to get another opinion would Dr. Benzel be the person to see? I noted a paper on cervical spine complications in RA that was co-authored by him in Jan. 2000.

Or should I be seeing a neurologist, because we haven't definately confirmed it is RA complications.  I definately want to see someone who would look at the films. As a consumer of healthcare I know that radiologist reports don't always tell the whole story. I have had a couple of x-rays incompletely or mis-read. The neurologist I have seen only reads reports.



Blank
Avatar_n_tn
Dear Judy:

If you decide to come to CCF, I would recommend to see Dr. Sweeney, Lederman, or Shields (all neurologists).

CCF Neuro MD
Blank
Avatar_n_tn
Has anyone experienced facial numbness?
If so, was a cause determined?
Blank
Avatar_n_tn
Facial numbmess can be a symptom of TMJ (Temporomandibular Joint Syndrome), where the joint that connects your jaw to your skull is misaligned and gets inflamed, causing muscle spasms and pain around the whole side of the head.  I've had it so bad that half my face goes numb as well with the pressure, pain, and dizziness.  Stress makes the problem get worse.  This is a very underdiagnosed condition that can cause alot of problems including vision and hearing problems.  It is treated with a bite plate and NSAIDS and muscle relaxants.  Talk to your dentist.  It's worth a shot.
Blank
Avatar_n_tn
Hi Anonymous,

Thanks for the info about TMJ. Can a regular dentist diagnose this problem or would I need to see a specialist? If so, what kind?

My dentist is aware of this problem, due to the fact that having my teeth cleaned causes major numbness. But, he hasn't recommended anything for me to do.

Blank
Avatar_n_tn
Hi Stella,

Are your symptoms similar to the ones I describe above?

Thanks,
Judy
Blank
Avatar_n_tn
I have had long history since 1987 injury spinal stenosis at c3-4 to c6-7. Because of this i find i am either putting constant pressure on my molars or opening my mouth to relieve neck pain..Recently last two months i have found when i opened my mouth wide my lower jaw that connects up toward the ears is offset and pops a little.. I also have this tremendous pressure pushing from behind the ear which gives ear pain..I had a ct scan done ordered by my family doctor which indicated severe sinus blockage he put me on 1700 mg antibiotics for 1 month when that didn't work he sent me to an ent who looked at the scan and prescribed zpack which had little imprvement he now wants to do surgery. From listening to writers their symtoms (symptoms) seem similar to mine. Also i have never had a sinus problem in my life and i am 51yoas. Should i go see a oral surgeon before having surgery to see if i might have TMJ
Blank
Avatar_n_tn
I have had long history since 1987 injury spinal stenosis at c3-4 to c6-7. Because of this i find i am either putting constant pressure on my molars or opening my mouth to relieve neck pain..Recently last two months i have found when i opened my mouth wide my lower jaw that connects up toward the ears is offset and pops a little.. I also have this tremendous pressure pushing from behind the ear which gives ear pain..I had a ct scan done ordered by my family doctor which indicated severe sinus blockage he put me on 1700 mg antibiotics for 1 month when that didn't work he sent me to an ent who looked at the scan and prescribed zpack which had little imprvement he now wants to do surgery. From listening to writers their symtoms (symptoms) seem similar to mine. Also i have never had a sinus problem in my life and i am 51yoas. Should i go see a oral surgeon before having surgery to see if i might have TMJ
Blank
Avatar_n_tn
I would get the TMJ possibility checked out and a second opinion regarding surgery.

Judy
Blank
Avatar_n_tn
I just wanted to let Judy know that having read her complaints/concerns that she may have ended 3 years of misery I have been experiencing. Very similar to hers. The only difference being is I am 29 and am very frustrated as well. I tried the cervical colar and my symptoms disapeared after 3 weeks having suffered the effects for nearly 36 months. Thanks Judy!
Blank
Avatar_n_tn
Hi Judy,
I am a 47 year old male and I have just recently started to get facial numbness on the left side of my face. The first time I saw a doctor for this was just yesterday, 12/10/00. They did some blood work and found nothing out of the ordinary. They also did some vision examines and found nothing out of the ordinary. I have a history of migranes (migraines) and in the past several months I had experienced heart palpatations. Imitrex was successful for the treatment of the migranes (migraines) and At the hospital last evening they gave me a shot of imitrex.  The numbness disapeared within a short time. About an hour. However as I sit here typing, the numbness has returned and is a little more extreme than before. I have a little numb feeling in my thumb and forefinger but I have suffered from carpal tunnel syndrome and just figured that it was from that. (the finger numbness). You speak of RA, and I'm not sure what that is. I am going to contact my family doctor to get his advice on what to do next.  I would like to keep in touch with you to see how you progress.  If you don't mind.
Blank
Continue discussion Blank
Blank
Request an Appointment
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
469720_tn?1388149949
Blank
Abdominal Aortic Aneurysm-treatable... Blank
Oct 04 by Lee Kirksey, MDBlank
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank