Tingling in both cheeks on my face/both front-sides muscles in my neck pulling

[Darlene111]

I was diagnosed with possible cervicogenic vertigo and went through vestibular rehab. I just completed 6 weeks of vestibular therapy and the rocking sensation is 80-90% gone. About 1 year ago I started having tingling in my right cheek on my face that would come and go. Then about 6 months ago I started having muscle pulling in the front/side of my neck, just on the right side. Last week the left side of my face is starting to tingle, and I am again getting the neck muscle pulling. These feelings in my neck and on my face are very scary and uncomfortable!! I have had 2 brain MRI's w/and without contrast one in 2007 and one in 2008 for the vertigo and they turned out normal. I had a cervical MRI w/and w/out contrast 2 months ago and it shows C4,5,6 shallow bulging disc, mild enroachment into the neural foramina bilaterally w/out neurocompressive findings. I had 1 set of trigger point injections in my neck 1 month ago which took away the tingling in my face and pulling in my neck for 10 days, but it's back again. Should I try facet injections?  Everything I read about vertigo, tingling in the face, pulling in the neck all have MS as a possibility. I have been seeing a ENT and a Neurologist and they have never said MS but when I mention my face and neck they don't seem worried. They say I have passed the physical neurological exam and never say anything more. Any ideas?

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

As you mentioned, symptoms of vertigo, tingling, neck symptoms etc. often do occur in multiple sclerosis. However, as you know they can occur in several other conditions. To make the diagnosis of multiple sclerosis there are specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and often needed to make the diagnosis of MS. It sounds like you have had 2 negative brain MRIs and a cervical MRI; a negative MRI makes MS extremely unlikely.

There are several causes of vertigo, one of which is cervicogenic vertigo. As you know, dizziness can have many causes. Vertigo, or "room-spinning dizziness" can be caused by several different types of inner ear problems and less commonly from central nervous system diseases. Cervical disease (such as a herniated disc in the cervical (neck) region or arthritis of the spine) can cause vertigo, though this is not common. More often, the dizziness is not room-spinning per se but rather a wooziness or sort of light-headed dizziness. I will refer to this as cervicogenic dizziness. This notion of cervicogenic dizziness is not accepted by all medical practioners, it is controversial, as it is not well researched, difficult to diagnose, and difficult to conduct research on. However, it may be diagnosed in someone with neck pathology and dizziness in which no other cause is found. Therefore, it is a diagnosis of exclusion, after inner-ear and brain problems are excluded. Patients with dizziness due to neck pathology (cervicogenic dizziness) often complain of dizziness that is worse with particular head movements and when the head is maintained in one specific posture for prolonged periods. Neck pain and a headache in the occipital region (the back of the head above the neck) may be associated with the dizziness. The dizziness may last minutes to hours after assuming certain head positions. Treatment includes physical therapy, vestibular rehabilitation, and medications if pain occurs. Facet joint injections are indicated in the case of pain due to spinal column problems such as due to arthritis.

Other causes of vertigo can include inner ear problems, of which there are a variety including Menniere's disease (which is marked by episodes of vertigo, ear-ringing (tinnitus) and hearing loss), Benign positional vertigo (BPPV) which is marked by episodes of vertigo brought on by head movement, brain tumors (this would be apparent on MRI), certain toxic drugs (specific medications), vitamin deficiencies, neuropathy, and certain infections. Inner ear problems are best evaluated by an ENT.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[jp518]

Have you been checked for B12 deficiency?  It can present like MS.
J

[Darlene111]

No, but I can ask my pcp to do it right?
Do my symptoms sound like MS?

[jp518]

I think your symptoms sound like some of mine. I have been diagnosed with a B12 deficiency (a simple, and relatively inexpensive blood test) and I have had some of the same symptoms. Of course, I also have cervical spine bulges and stenosis, and am wondering if my dizziness is related to that. I also went for ENT testing, which came out negative for vestibular disorders.  

Google B12 deficiency and see if the symptoms sound like yours.  I was very surprised by what this deficiency can do.  Also, it will help when you go to your pcp if you can present a case, because some doctors don't know much about the physical symptoms of b12 deficiency, or think you have to have anemia for it to be an issue. B12 deficiency can sound like MS , but is much easier to treat.  It can also cause symptoms similar to Alzheimer's.

I personally think my dizziness is related to my cervical spine, but doctors in my clinic don't "believe" in cervicogenic dizziness.  They haven't figured out anything else, though, and don't seem to think the B12 deficiency is causing the dizziness.  B12  supplements did reduce the tingling in my face, arms and legs, improve my energy and concentration.  I'm still dizzy and stumble, though.

Definitely wouldn't hurt to run this by your doctor.
Judy