Facial and Scalp Numbness: Causes and Next Steps

Q: Facial and Scalp Numbness: Causes and Next Steps

Hello, Miss： You mentioned that "the right side of the scalp and cheek area experiences intermittent numbness, and occasionally there is a tingling sensation near the nose." The MRI report did not reveal any lesions related to the trigeminal nerve. <br>The symptoms should be cons

Regarding facial and scalp numbness (medical examination has been conducted)?

Hello, doctor.
For the past two months, I have been experiencing intermittent numbness on the right side of my scalp and cheek, and occasionally around my nose.
I do not have diabetes, hypertension, or heart disease (all tests have been done).
Additionally, my cheeks have been sore.
I consulted a neurologist who conducted blood tests for thyroid function, which were normal, performed an EEG (which was normal), and found issues with nerve conduction.
However, the doctor did not specify any problems and referred me for a brain MRI.
The report indicated: "Routine blink reflex study revealed no pick up right r2 and r2’ but normal at left side.
Suspect right CNV pathway lesion." Upon reviewing the MRI report, I was informed that there were no abnormalities.
The report states:
"The supine position superconductive 1.5T brain MRI with surface coil was performed for this suspect trigeminal neuralgia patient.
The pulse sequences included axial T1WI, T2WI, SWI, and FLAIR, with coronal and axial thin 1mm slice thickness posterior fossa T1WI and T2WI studies.
No intravenous gadolinium was administered.
The axial functional brain images (DWI and ADC maps) were also performed.
Findings: 1.
No focal mass lesion, no abnormal signal intensity change nor midline shifting seen within the brain parenchyma.
2.
No acute intracranial hemorrhage is seen.
3.
The intracranial vessels still show normal flow voiding.
4.
The ventricular size is normal.
5.
Clear appearance of bilateral paranasal sinuses and bilateral mastoid antri.
6.
Bilateral cerebellopontine cisterns and parasellar regions show no focal mass lesion; the cisternal segments of bilateral trigeminal nerves are well-seen.
No external compressive mass effect nor displacement occurs.
7.
The axial functional whole brain images (diffusion-weighted images and ADC maps) show no acute ischemic infarction, no acute inflammatory lesion nor tumor mass lesion.
8.
The 3D intracranial T.O.F MR angiography shows no vascular malformation or saccular aneurysm.
No apparent focal vessel luminal stenosis or flow interruption occurs.
Impression: Bilateral cerebellopontine cisterns and parasellar regions show no focal mass lesion; the cisternal segments of bilateral trigeminal nerves are well-seen.
No external compressive mass effect nor displacement occurs.
The axial functional whole brain images show no acute ischemic infarction, no acute inflammatory lesion nor tumor mass lesion.
The 3D intracranial T.O.F MR angiography shows no vascular malformation nor apparent focal vessel luminal stenosis.
Redundant course.
Suggest correlate clinically and regular follow-up."
Currently, I still do not know why my right cheek and scalp are numb.
The doctor prescribed medication, and I noticed that the prescription included mecobalamin, noting that it was confirmed as chronic multifocal lesions.
I have a few questions: 1.
Aren't multifocal lesions quite serious? However, the doctor did not mention it at all.
2.
If I continue to experience numbness after taking the medication, should I seek further evaluation elsewhere? 3.
The attending physician mentioned that it is possible I have a naturally slow nerve response; is this a possibility? 4.
Recently, I had an eye examination, and the ophthalmologist noted that my right pupil constricts more slowly than the left; could this be related? I apologize for the lengthy message, but I am really troubled and uncomfortable, and I am unsure what to do next.
I would greatly appreciate your advice and answers.
Thank you.

Niming, 30~39 year old female. Ask Date: 2022/11/17

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned that "the right side of the scalp and cheek area experiences intermittent numbness, and occasionally there is a tingling sensation near the nose." The MRI report did not reveal any lesions related to the trigeminal nerve.
The symptoms should be considered for trigeminal neuralgia, which typically presents unilaterally and rarely occurs bilaterally at the same time.
Pain is usually more common in the maxillary and mandibular branches, characterized by severe, superficial, sharp, paroxysmal pain, with intensity ranging from moderate to severe.
Additionally, it may be necessary to consider trigeminal autonomic cephalalgia (TAC), which is a group of headache syndromes associated with significant cranial autonomic symptoms.
These syndromes primarily manifest activation of the trigeminal parasympathetic reflex (such as miosis and nasal congestion), while also exhibiting secondary clinical signs of cranial sympathetic dysfunction (such as sweating in the forehead and face).
I recommend discussing further examination and treatment options with your attending physician.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2022/11/17

More Info

Facial and scalp numbness can be concerning and may arise from various underlying causes. Based on your description, it seems you have undergone a thorough evaluation, including blood tests, nerve conduction studies, and MRI scans, which have largely ruled out significant structural abnormalities or acute neurological issues. However, the persistent symptoms you are experiencing warrant further discussion and understanding.

1. Understanding Multiple Lesions: The term "chronic multifocal lesions" can indeed sound alarming, but it is essential to understand the context. These lesions may not necessarily indicate a severe condition. They could be related to various benign processes, such as small areas of demyelination, which can occur in conditions like multiple sclerosis or other inflammatory processes. However, the absence of acute lesions or significant findings on your MRI suggests that these may not be the primary cause of your symptoms. It is crucial to have a detailed discussion with your neurologist about the implications of these findings and whether they require further monitoring or intervention.

2. Medication and Follow-Up: You mentioned being prescribed mecobalamin, which is a form of vitamin B12 often used to treat neuropathic pain and support nerve health. If you find that your symptoms persist despite taking the medication, it is advisable to follow up with your neurologist. They may consider additional diagnostic tests or alternative treatments. Persistent numbness can sometimes indicate a need for further investigation, such as additional imaging or referral to a specialist in neuromuscular disorders.

3. Inherent Nerve Response: Your doctor’s suggestion that you may have a naturally slower nerve response is plausible. Some individuals may have variations in their neurological function that do not necessarily indicate a pathological condition. However, this should be evaluated in the context of your overall health and symptoms. If this is a new development, it may be worth exploring further.

4. Pupil Reaction and Neurological Correlation: The observation by your ophthalmologist regarding the slower constriction of your right pupil compared to the left could be relevant. This phenomenon, known as a relative afferent pupillary defect, can indicate an issue with the optic nerve or pathways involved in pupillary response. It is essential to discuss this finding with your neurologist, as it may provide additional clues about your neurological status.

In conclusion, while your symptoms of facial and scalp numbness are understandably distressing, the comprehensive evaluations you have undergone have not revealed any acute or life-threatening conditions. It is essential to maintain open communication with your healthcare providers, express your concerns, and ensure that you receive appropriate follow-up care. If your symptoms worsen or new symptoms arise, do not hesitate to seek further medical attention. Consider keeping a symptom diary to track any changes, which can be helpful during your consultations. Your health and comfort are paramount, and persistent symptoms should always be taken seriously.

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