Stroke Symptoms: Facial Twitching and Other Concerns - Neurology

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Stroke, facial twitching?


Hello Doctor, on September 5th while cleaning the floor during my shower, I experienced a noticeable feeling of cerebral congestion, but it subsided after a while, occurring two or three times.
Since I was cleaning a new house, the air quality was poor, and I stayed there overnight.
I went to bed at 11 PM but woke up three or four times during the night due to discomfort from changing pillows.
The next morning, my eye pressure was measured at 26/23.

On September 6th, after returning home in the afternoon, I suddenly had a nosebleed, but it stopped quickly.
Later that evening, while sleeping at my old home, I experienced another nosebleed, which also stopped quickly.
About ten minutes after the bleeding stopped, I lay down to sleep.
I felt some cerebral congestion that made it hard to fall asleep, but eventually, I did.

On the morning of September 7th, I visited an ophthalmologist, and my eye pressure was 21/21, with no signs of glaucoma.
That night, while lying flat to sleep, I felt a pressure in my head and had a mild headache, which was quite uncomfortable, so I had to elevate my head to sleep better.

On September 8th, during a midday nap, I had the sensation of falling asleep three or four times but woke up for unknown reasons.
Eventually, I fell asleep without realizing it.
Later that afternoon to evening, I felt a heaviness in the back of my head (very subtle), but I experienced mild headaches that would last for about a minute, moving from left to right.
When I yawned, it felt like air wasn't reaching the back of my head, but I didn't feel dizzy when lying flat.

I've been yawning continuously for five days, and I'm unsure if it's due to poor sleep or a lack of oxygen to my brain.
My family has a history of hypertension, so I sometimes feel my blood pressure rising; my recent measurements have been around 140/77/55.
My blood sugar was around 103 last month.

In the past, my left foot would occasionally feel numb, but that sensation would go away in about a minute and doesn't occur frequently.
My left mouth corner twitches, but it doesn't happen when both corners move together.
I'm worried that these might be signs of a stroke, but I have tested using the FAST method and found no abnormalities.
Therefore, I would like to ask you some questions:
1.
Doctor, could I be experiencing stroke symptoms or is this due to autonomic nervous system dysfunction?
2.
I have intermittent strabismus with a significant angle, which makes it tiring to focus; could this be a reason for my frequent yawning?
3.
Recently, I've been yawning continuously five to six times, but then it stops, only to return at night; is this related to a stroke?
4.
Doctor, is a carotid ultrasound sufficient to assess the risk of a stroke?
Thank you, Doctor!

Wang, 20~29 year old female. Ask Date: 2021/09/09

Dr. Jiang Junyi reply Neurology


Hello, Sir:
(1) Doctor, could my symptoms be a precursor to a stroke or caused by autonomic nervous system dysfunction? Your symptoms seem more indicative of cervical spine issues.

(2) I have intermittent strabismus with a significant angle, which makes it tiring to see things.
Could this be a reason why I sometimes yawn? I'm not sure about your sleep quality; I recommend using a smart wristband to monitor it.

(3) Recently, I've been yawning consecutively 5 to 6 times, and then it stops.
This occurs at night; is this related to a stroke? Long-term poor sleep and elevated blood pressure may accelerate vascular aging.

(4) Doctor, is a carotid ultrasound sufficient to assess the risk of a stroke? Generally, risk factors for cerebral infarction include older age, diabetes, hypertension, and arrhythmias.
To diagnose a cerebral infarction, in addition to symptoms, brain imaging studies such as CT or MRI can be arranged.

Thank you for your questions, and feel free to discuss any related issues! Wishing you good health.

Dr.
Jiang Junyi, Peace and Happiness Medical Clinic.

Reply Date: 2021/09/09

More Info


Understanding the symptoms of a stroke is crucial, especially when experiencing unusual sensations such as facial twitching, headaches, or feelings of pressure in the head. Your detailed account of symptoms raises several important considerations regarding potential neurological issues, including the risk of stroke.

1. Stroke Symptoms and Concerns: The symptoms you describe, such as the feeling of "brain congestion," nasal bleeding, and intermittent headaches, can be concerning. While these symptoms do not definitively indicate a stroke, they warrant careful evaluation. The FAST method (Face drooping, Arm weakness, Speech difficulties, Time to call emergency services) is a useful tool for identifying stroke symptoms. Since you mentioned that you did not observe any abnormalities during the FAST test, it is reassuring, but it does not completely rule out the possibility of a transient ischemic attack (TIA) or other neurological issues.

2. Autonomic Nervous System Dysfunction: Your symptoms could also be related to autonomic nervous system dysfunction, which can manifest as fluctuations in blood pressure, feelings of pressure in the head, and fatigue. The fact that you have a family history of hypertension could contribute to your symptoms, as high blood pressure can lead to vascular changes that increase stroke risk.

3. Yawning and Fatigue: The frequent yawning you are experiencing may be a response to fatigue or could indicate a lack of oxygenation, particularly if you are not sleeping well. Yawning is often a physiological response to tiredness or a way for the body to increase oxygen intake. Given your history of intermittent strabismus, visual fatigue could also contribute to your overall sense of discomfort and fatigue, leading to increased yawning.

4. Diagnostic Evaluation: Regarding your question about stroke evaluation, a carotid ultrasound is indeed one of the initial tests used to assess blood flow in the carotid arteries and can help identify any blockages that may increase stroke risk. However, a comprehensive evaluation may also include brain imaging (such as a CT or MRI scan) to assess for any signs of stroke or other neurological conditions. It is essential to discuss your symptoms with a healthcare provider who can recommend appropriate tests based on your clinical presentation.

In summary, while your symptoms may not directly indicate an impending stroke, they do suggest the need for further evaluation to rule out any serious conditions. It is crucial to consult with a neurologist or your primary care physician to discuss your symptoms in detail, undergo appropriate diagnostic tests, and receive tailored management strategies. Early intervention can significantly improve outcomes and help address any underlying issues contributing to your symptoms.

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