Neurological Symptoms: When to Seek Further Medical Help - Neurology

Numbness in the head, facial numbness, and finger twitching, etc?

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Hello Dr.
Tsai, a year and a half ago I experienced chest numbness, chin pain, pain in my left shoulder and left arm, and soreness in my left fingers and wrist.
Subsequently, I developed numbness on the right side of my scalp and right cheek, prompting me to visit two major hospitals for cardiac and neurological evaluations.
I also noticed that certain objects appeared to vibrate in my vision (especially black and white patterns), and I underwent a fundoscopic examination, which showed no issues.
Additionally, I experienced sharp pain in my left inner ear; when listening with my left ear, I heard a popping sound in my right ear.
I had a hearing test (before the MRI of my brain), which also indicated no problems, but none of the above symptoms improved or alleviated.

Regarding my heart, both hospitals performed echocardiograms, and both doctors reported no issues.
However, I still felt very uncomfortable in my chest, so I underwent an upper endoscopy, which revealed gastroesophageal reflux disease (GERD).
I also experienced upper abdominal pain (I had a CT scan, but the abdominal specialist reported no issues with my internal organs).
For my head, an electrophysiological test showed abnormalities in the facial nerve conduction to the brainstem, leading to an MRI of the brain, which the doctor also reported as normal.
My thyroid function was also normal.

After starting medication, my symptoms lessened but did not completely disappear (they occasionally flare up).
Last month, I was troubled by sleep issues, which I have had for a long time but worsened recently (essentially, I find it very difficult to fall asleep, and even when I do, I can only sleep for 3-4 hours).
A few days later, I began to experience numbness in my left face, left scalp, right face, and right scalp, along with involuntary twitching of my left eyelid and left fingers.
My cheeks also became sore, and then my chest started to feel numb again, with pain in my left teeth, sharp pain in my left inner ear, and renewed pain in my left shoulder (where I carry my bag) and left wrist and fingers, accompanied by eyelid twitching.
This time, I experienced numbness on both sides of my head and face.
I returned to the neurology department, where I underwent the same test that had previously shown abnormalities (using facial electrodes and electrical stimulation).
This time, the report indicated no abnormalities.
However, I still experience persistent numbness in my head and face, involuntary twitching and soreness in my left fingers, and occasional discomfort in my arms and elbows, along with chest numbness, esophageal pain, numbness in my back (around the scapula), and dental pain, chin, and cheek pain.
The doctor only prescribed the same medications as before without further explanation of the cause.

Could you please advise me on which direction I should take for further medical evaluation? I have been seeking treatment but have not received definitive answers, and the pain is quite distressing.
I apologize for the lengthy message and would greatly appreciate your guidance.
Thank you.

Additionally, I have included my examination data.
Thank you, Doctor.
This year, my blood sugar levels have been around 105-110 before meals and are under control.
My blood pressure ranges from 115-130/78-90, but I am overweight.

Brain MRI findings: The supine position superconductive 1.5T brain MRI with surface coil was performed for this suspected trigeminal neuralgia patient.
The pulse sequences included axial T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), susceptibility-weighted imaging (SWI), and fluid-attenuated inversion recovery (FLAIR).
Coronal and axial thin 1mm slice thickness posterior fossa T1WI and T2WI studies were conducted.
No intravenous gadolinium was administered.
The axial functional brain images (diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps) were also performed.

Findings:
1.
No focal mass lesions, abnormal signal intensity changes, or midline shifting were observed within the brain parenchyma.

2.
No acute intracranial hemorrhage was detected.

3.
The intracranial vessels showed normal flow voiding.

4.
Ventricular size is normal.

5.
Clear appearance of bilateral paranasal sinuses and bilateral mastoid antra.

6.
Bilateral cerebellopontine cisterns and parasellar regions showed no focal mass lesions; the cisternal segments of bilateral trigeminal nerves were well visualized.
No external compressive mass effect or displacement was noted.

7.
The axial functional whole brain images (DWI and ADC maps) showed no acute ischemic infarction, acute inflammatory lesions, or tumor mass lesions.

8.
The 3D intracranial time-of-flight (T.O.F) MR angiography showed no vascular malformations or saccular aneurysms.
No apparent focal vessel luminal stenosis or flow interruption was observed.

Impression: Bilateral cerebellopontine cisterns and parasellar regions showed no focal mass lesions; the cisternal segments of bilateral trigeminal nerves were well visualized.
No external compressive mass effect or displacement occurred.
The axial functional whole brain images showed no acute ischemic infarction, acute inflammatory lesions, or tumor mass lesions.
The 3D intracranial T.O.F MR angiography showed no vascular malformations or apparent focal vessel luminal stenosis.
Regular clinical correlation and follow-up are suggested.

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Niming, 40~49 year old female. Ask Date: 2024/05/29