chronic facial pain and numbness

[ahmedkq]

My illness started gradually from more than 10 years. It srtarted with loss of feeling in my right
face half. and after several years this losss of feeling (numbness) had a pain associated with it branch 2 and 3 of TG nerve.
This pain is not in form of pulses but it is burning dull contineus pain. It increases with stess
but it can increases without stress too.
I saw more than 10 neurologist and they tried with me tegretol, neuontin, vitamin B, Tricyclic
antidepressants, ...... and much more but without a significant result.
I did MRI on my brain and it showed something like multiple scelorosis but most of doctors advised
me to ignore and told me this is not MS disease because you don't have any complaint except your
face. The pain increases from year to other and I stopped all medications except cipralex (SSRI
antidepessant) because I am depressed from the illness.
By the way is ther any possibility of this illness to be caused by sinusitis?
Any one has advice?
Ahmed Kamal

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

Without examining you and reviewing the scan, I cannot make a diagnosis. A question to ask the neurologists is does the MRI show a lesion to explain your symptoms. Since there does not appear to be spreading of the problem, perhaps focusing on pain treatment would be reasonable. It does not sound typical for trigeminal neuralgia, but there are other nerve blocks which can be attempted. Seeing a specialist in pain management would be recommended. Good luck.

[ahmedkq]

Thanks a lot for your reply. As I understood there nothing in the MRI justify the pain .. please find below the report of the two MRIs I had done:


The first MRI:
22/6/1999 Specialized Hopspital Ain Shams University

Different pulse sequences in different planes revealed:-
-Two tiny bright foci (+3mm) on T2 and PD WI seen within the periventricular region (images 15,16 plato II).
-No shift of mid-line structures.
-Normal site, size and shape of the ventricular system.
-No intracerebral hematoma nor extra-axial collection.
-Normal MRI structural apprearance of the posterior cranial foss pituitary gland and craniocervical junction.

Opinon:
********
-Two tiny bright, foci on T2WI which may represent in this age group demyelinating disease (MS) versus ischemic changes 2ry vasculitis for further investigations.

Dr.Ahmed Monib

###########################################################################################

The second MRI:
15/1/2003 ALFA SCAN

MRI TECHNIQUE:
**************
*Sagittal T2 wted images 6mm sections (plate1)
*Axial T1 & T2 wted images 5mm sections  (plates 2,3 &4)
*Coronal FLAIR images 5mm sections (plate 5)

MRI FINDINGS:
**************
*Mutiple tiny (<1cm) foci of abnormal signal intensity are seen scattered at the periventricular and subcortical zones of both temporal and occipital lobes. They appear bright on T2 and FLAIR images and some of which are of low signal intensity on T1-WIs. No mass effect.
*Normal ventricular size and configuration. No midline shift.
*Normal size and signal intensity of the brain stem and cerebellum.

Opinion:
********
Multiple bilateral temporal and occipital foci of abnormal signal intensity most likely representing demyelination plaques.


Prof.Dr.Khaled Talaat
Dr.Mohamoud Abdel Azeem




Many thanks for your great help

[ahmedkq]

I have also a question, one time a neurosurgeon has suspected that the cause of such numbness and pain is a complication for chronic sinuses, but I did not follow this opinion at this time because one one else has said the same suggession, Is it worthy in your opinion to track this opinion? and if what kind of scan I can do to clarify this problem?

Many thanks

[aliaat]

Hi Ahmed,

First, I don't think the doctor will reply to your follow up, you may have to put in a new post if you can.  Second, I am not a doctor, but I had a few thoughts about your situation.  First, one of the docs in your report mentions 'may represent in this age group demyelinating disease (MS)'.  Did you ask him if he thought these areas of white matter changes were related to your facial pain?  When I had an MRI last year (before getting diagnosed with MS), they detected a lot of white matter changes, including in the periventricular white matter.  The neurologist said that a lot of these changes can be 'clinically silent', meaning they can cause no problems, but are seen on imaging.  So, you should probably ask the neuro about the relationship (if any) between where these lesions are and your clinical symptoms.

Second, the first report states 'Two tiny bright foci (+3mm) on T2 and PD WI seen within the periventricular region', and the second 'Mutiple tiny (<1cm) foci of abnormal signal intensity are seen scattered at the periventricular and subcortical zones of both temporal and occipital lobes'.  Do they suggest that more changes have developed, or is this simply a reporting discrepancy?  Because this may (or may not) be significant.  You could also ask them that.

Finally, what about migraines?  And other tests (EMG, lumbar pucture, etc.)?  These can be useful to support or eliminate any diagnosis.  

BE PERSISTENT WITH THE DOCTORS.  I know from experience that although we have some great docs in that part of the world, you really have to be quite persistent in asking them very specific questions, otherwise you just get a brief summary.  So do some research, write the questions down, and ask!  All the best.