Re: Tingling and facial numbness

Posted By CCF Neurology MD:NT on November 25, 1998 at 00:14:16:

In Reply to: Re: Tingling and facial numbness posted by Lone on November 24, 1998 at 03:17:27:






: : : : Im a female, 29 yeras old. I have a numb feeling on the left side of my face  and tingling in hands, feet, legs, arms and sometimes in my back. I have a burning feeling on top of my head and it sometimes feels like I have cotton in my ears. I have no coordination problems, no bladder problems and my eye seem to work normally.
: : It all started when I was pregnant with my secon child, almost 2 years ago. I felt a tingling on my upper lip and this spred to the cheek within 4-5 days. When I first felt the tingling/numbness on top of my left hand, I was hospitalized and had an MRI and a CT scan. All came out normal (like my little babygirl).
: : The numbness in my face spred slowly and never went away. After about
: : : : 4 months I had a spinal tap and a nerve conducting test. All was normal, except the visual evoked potentials test. Here the result was 110 millisec. (on both eyes) were it normally should have been under 100. What does that mean to you?
: : On my one request, Im going to have a 2nd. MRI tomorrow and Ill repeat the evoked potentials test in December. IF I have MS, I want to know it.
: : My problem really is, that I cant see what else it can be, if its not MS.
: : : : I havent read about a single person hwo had numbness and tingling, and then it suddenly disappeard all by it self. On the other hand, I have read about alot of people hwo first got the MS diagnosis after second or third MRI and offen several years after their symptoms started. Thats what Im afraid of!
: : My doctor dosent seem convinced that I have MS, but he cant say I havent. I havent got any severe symptoms since it all started almost 2 years ago - thats a good sign, he says.
: : : : What do you think? What else can it be?
: : Thank you for your time.
: : : : Karina
:


  =
: Dear Karina:
: Contrary to what you state, numbness that comes and goes (and never gets diagnosed as anything serious!) is far more common that similar numbness from MS. It is entirely appropriate to undergo a full evaluation for MS, and even some other neurological conditions such as sensory neuropathy, when there are such symptoms.
: : : You have already had such a work-up. The only abnormal test that you mention is a mild symmetric bilateral prolongation of VEPs. Unlike unilateral prolongation of the VEP, bilateral prolongation is relatively non-specific and may even occur due to some technical factors. It does not have the same diagnostic significance as an abnormal inter-eye latency difference.
: Reading your description, I do not think MS is a very likely diagnosis in your case. Nobody, however, can assure you that you do not have MS, because the tests that you enumerated are not a 100 percent sensitive. After undergoing a reasonable work-up that is unrevealing, the best policy for the patient and the neurologist is observation over time. Despite our relatively advanced current-day diagnostic methods, uncertainty is something a patient may have to learn to live with.
: : : Let me assure you that not being able to figure out a diagnosis is a better state to be in than knowing that you have MS, specially if you are clinically stable or improving.
: Good luck, and take care!
Thank you very much for your answer.
: : It relieved me to read your opinion.
I have another short question, if its ok?
: : Although my symptoms is mainly in the face, I also get
: : a burning feeling in the loin, sometimes.
: : Could it be a good idea to have a MRI of the spine?
: : (Especially if my 2nd. MRI of the brain is normal)
Thank you for being there for all of us!
: : Lone
Some additional info:
N.B: My name is Lone, but I call myself Karina.
:        Confusing - sorry! Hope youll answer anyway.
N.B: My numbness (facial) does not come and go.
:        Its there all the time. The intensity of the tingling
:        vary, but it has never totally disapeard.



      =


: : Dear Lone/Karina:
So long as you do not progress or get new symptoms, "sitting tight" may be a good idea. I am not sure a spine MRI would help very much if your only symptoms are mild sensory ones over the trunk.
Only sensory symptoms may be from a sensory neuropathy, although this is somewhat less likely with a normal EMG. If you have a dry mouth and dry eyes, of suffer from other unusual symptoms such as arthritis, painful blue hands in the cold, eye problems, ulcers, weight loss, fevers, etc, getting yourself checked out for connective tissue disease by a rheumaologist may be a good idea.



      =


: Dear "NT" (MD)
Is the evoked potentials test (VEP etc.) the same as EMG?
If not (as I believe), I havent had an EMG test... yet.
Should I ask for it? I have heard that they use large (!) needles,
(it must hurt!) but Ill do it if it can help me get diagnosed and
maybe even treated for what ever there is wrong with me.
Can you tell more about this test? (I thought it was only indicated
when you have motory problems) How is it performed?
I did actually see an eye specialist about 4-5 years ago, who told
me I might have Sjoegreens disease (What is that?). I went to see
him because I always had (and still have) very irritated eyes (dry?!)
although Im not allergic to anything (except cats). I dont have arthritis or blue hands in the cold, but I have "white fingers syndrome" and alot of problems with my throat. Last november I had my tongue-tonsils (!) removed, because they cept on growing, and I could hardly breath when they where inflamed. I still have "throat age" very very often, and the tonsil tissue has "grown" out again (both in the normal area and on the back of my tongue). The doctors think my troath looks very strange (!) but they cant explain why. I guess I have to live with it.
Another problem I have which might affect the bloodcirculation (and maybe even cause some of my other problems) is that I never feel thirsty. I have to remind myself to drink, and when Im buissy I often forget. My husband
try to help by offering me something often, but Im still quite dehydrated all the time. That gives me extremely dry skin and might also cause the dry eyes - I guess. My hands get chapped eventhough I use lotion often.
I know I should drink, but cant/dont. Why??? It has always been like this.
I sorry to write about other things than MS.
But maybe these other symptoms is connecetd with the tingling???
Please help me!
Lone




Dear Lone:
It is interesting that you mention Sjogren's syndrome. Sjogren's syndrome is one of the more common causes of a sensory neuropathy, the symptoms of which can be identical to what you suffer from. The nerve conduction test (which is part of the EMG examination- which is not the same as a VEP) is something you mentioned you have had, and was normal. This test is usually abnormal in sensory neuropathy from Sjogren's syndrome. Nevertheless, I suspect it is worthwhile looking into the possibility more closely.
A test thst is often done to diagnose Sjogren's with greater certainty is a lip salivary gland biopsy. They commonly show inflammation and infiltration with lymphocytes. An EMG examination may be very important to determine the presence and type of neuropathy. It is only mildly painful and most individuals tolerate it well.
If your symptoms are persistent and bothersome, and if no diagnosis is reached, it might be a good idea for you to seek a second opinion from a neuromuscular specialist form a major academic neurology department near you. In case Cleveland is practical, seeing Dr. Mitsumoto, Levin, or Shields at the Cleveland Clinic may be a good idea. Appointments are made by callin [phone], or [phone] locally.