Facial Numbness: Possible Causes and When to Seek Help

Stroke causes neurological damage?

Hello, Doctor! Four months after getting my front tooth crown, I started experiencing a tingling sensation in my right nostril, right cheekbone, and right ear.
Sometimes, the right side of my head also feels this way.
What could be the cause? Two years ago, I was diagnosed with carpal tunnel syndrome at Linkou Chang Gung Memorial Hospital, where I underwent an MRI and nerve conduction studies that showed mild damage.
Could this affect the tingling on the right side of my face? In the past six months, I have also frequently experienced slurred speech and a swollen tongue, and my descriptions of things are not as clear as they used to be.
I am very concerned that these symptoms might indicate a pre-stroke condition.
Which specialist should I consult for these issues? Below are the findings from my previous examination at Linkou.
Thank you for your assistance!
111/03/03 Imaging or Pathology Report
History: 41-year-old female, numbness.
Examination: MRI of the cervical spine without contrast enhancement.
Technique: Sagittal T1WI, T2WI, T2*WI, and axial T2*WI sections.
Findings:
1.
Alignment: Straightening of the cervical spine.
2.
Vertebrae: Normal.
3.
Disc: C4/5 left subarticular disc protrusion.
C3/4 and C5/6 central disc protrusions.
4.
Neuroforamen: Obliteration of the left epidural lateral recess at the C4/5 level.
5.
Ligament: Normal.
6.
Spinal canal: Normal.
7.
Spinal cord: Normal.
8.
Others: Nil.
Impression: C4/5 left subarticular disc protrusion.
C3/4 and C5/6 central disc protrusions.
111/02/25 Imaging or Pathology Report
A 41-year-old female; Clinical Information: Occasional posterior neck pain for months, with bilateral upper extremity numbness and weakness, especially in the right upper extremity.
Deep tendon reflexes: ++++, muscle power: decreased, especially in the right upper extremity, Lhermitte's sign: +, Hoffmann's sign: +, local tenderness: absent, muscle atrophy: absent.
For cervical and lumbar spinal X-rays, cervical spinal MRI, and upper extremity nerve conduction velocity and electromyography exams, rehabilitation treatment with a neck collar was advised first.
Radiography of the Cervical Spine A-P View, Cervical Spine Flexion + Extension Lateral View Show: Degenerative changes of the cervical spine with spur formation.
No definite dynamic instability at flexion and extension views.
Disc space narrowing at the level of C5-6.

Vivi, 40~49 year old female. Ask Date: 2024/03/01

Dr. Jiang Junyi reply Neurology

Hello Ms.
Vivi,
You mentioned experiencing "numbness on the right side of your face? This past six months, you've also had issues with slurred speech and a thick tongue." These symptoms do not seem to be explainable by cervical degeneration or herniated discs.
It may be worth considering abnormalities in brain structure.
I'm not sure if you have metabolic syndrome (such as increased waist circumference, elevated fasting blood sugar, or abnormal lipid levels), but if you do, you would be at a higher risk for stroke.
Additionally, smoking can contribute to cerebrovascular disease.
I recommend that you undergo an evaluation for risk factors related to brain and vascular diseases.
If you are concerned about radiation exposure, you might consider opting for a self-paid brain MRI for further assessment.
For nerve repair, it is advisable to supplement with B vitamins and manage risk factors.
Thank you for your inquiry, and I welcome further discussion.
I suggest consulting a neurologist for examination and treatment options.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi

Reply Date: 2024/03/01

More Info

Based on your description, it seems you are experiencing facial numbness and other neurological symptoms that have developed after dental work. The areas affected include the right side of your nose, cheekbone, and ear, with occasional numbness in the right side of your head. Additionally, you mentioned a history of carpal tunnel syndrome and recent difficulties with speech clarity, which raises concerns about potential neurological issues.

Possible Causes of Facial Numbness
1. Nerve Compression or Damage: Given your history of cervical disc protrusions, particularly at the C4/5 and C3/4 levels, it is possible that nerve roots exiting the cervical spine are being compressed. This can lead to symptoms such as numbness, tingling, or weakness in the areas innervated by those nerves, which may include parts of your face. The cervical spine issues could potentially affect the sensory pathways that contribute to facial sensation.

2. Dental Procedure Complications: The numbness you are experiencing could also be related to the dental work you underwent. If the procedure involved the upper jaw or the maxillary nerve (a branch of the trigeminal nerve), it could lead to transient or, in rare cases, permanent numbness in the facial region.
3. Neurological Conditions: While less likely, conditions such as multiple sclerosis or other demyelinating diseases could present with similar symptoms. The presence of speech difficulties and the feeling of a "thick tongue" could suggest involvement of cranial nerves, particularly if there is a central nervous system issue.

4. Stroke or Transient Ischemic Attack (TIA): Your concern about stroke is valid, especially given the speech difficulties. While your symptoms may not fit the classic presentation of a stroke, it is important to rule out any acute neurological events, particularly if you have risk factors such as hypertension or a history of vascular issues.

When to Seek Help
Given the complexity of your symptoms, it is crucial to seek a thorough evaluation from a neurologist. They can perform a comprehensive neurological examination and may recommend further imaging studies, such as an MRI of the brain, to assess for any abnormalities that could explain your symptoms.

Recommended Steps
1. Neurological Evaluation: Schedule an appointment with a neurologist as soon as possible. Bring all relevant medical records, including your previous MRI findings and any notes from your dental procedure.

2. Speech Assessment: If your speech difficulties persist, consider seeing a speech-language pathologist who can evaluate and provide strategies to improve your communication skills.

3. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their duration, and any associated factors (like stress or physical activity). This information can be invaluable for your healthcare provider.

4. Consider Physical Therapy: If your cervical spine issues are contributing to your symptoms, a physical therapist specializing in neck and spine rehabilitation may help alleviate some of the discomfort and improve function.

Conclusion
Facial numbness and associated symptoms can arise from various causes, including nerve compression, complications from dental procedures, or neurological conditions. Given your history and the complexity of your symptoms, a prompt and thorough evaluation by a neurologist is essential to determine the underlying cause and appropriate treatment. Early intervention can significantly improve outcomes and help alleviate your concerns.

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