Long-Term Left-Sided Facial and Scalp Numbness Symptoms

Long-term numbness on the left side of the face and scalp?

A patient with polio has been sitting for long periods.
(1) The left side of the face experiences intermittent numbness, particularly in the cheek and scalp, with symptoms persisting for two to three years.
The numbness does not occur daily but suddenly appears, starting from the left scalp and extending to the left cheek, with more frequent occurrences in autumn and winter, as well as during late nights and menstrual periods.
(2) Earlier this year, the patient noticed slight drooping of the left eye and some sagging of the left side of the face.
Additionally, the left eye tends to tear excessively, especially when lying on the side while sleeping, resulting in noticeable swelling and soreness upon waking.
(3) The patient has not had the left lower wisdom tooth extracted, and sometimes experiences soreness in the jaw; could this be related? (4) The left shoulder has been experiencing persistent pain for about two years; is there a connection, especially since the patient has a habit of sleeping on the left side? (5) There is frequent nasal congestion on the left side.
(6) In the past two months, the patient has noticed occasional twitching of the left upper eyelid and involuntary shaking of the left upper lip, but these symptoms only occur when sleep-deprived or fatigued.
This week, due to work-related stress, the patient observed that only the left index finger shakes involuntarily while typing, and there is occasional mild shaking even at rest, along with slight numbness on the inner side of the left hand.
(7) The left neck often feels sore, and sometimes a soft lump can be felt, though it may not always be present.
These symptoms have been a long-term concern for the patient.
I would like to consult a physician about what disease these symptoms may indicate, which specialty to visit, and what examinations and treatments should be pursued.

Zhen De, 30~39 year old female. Ask Date: 2015/10/09

Dr. Gao Chunde reply Neurology

The sensation in the left forehead and left cheek is associated with the left trigeminal nerve pathway, while the ptosis of the left eye and the weakness in the movement of the left side of the face are related to the left facial nerve pathway.
These two issues indicate a lesion in the left brainstem or the cranial base.
Just these two problems warrant further detailed examination by a neurologist.
If accompanied by left nasal congestion and a neck mass, in addition to neurology, an evaluation by an otolaryngologist for nasopharyngeal concerns is also necessary.
These symptoms may be caused by the same underlying issue, but a thorough examination is required to confirm the diagnosis.

Reply Date: 2015/10/09

More Info

Based on the symptoms you've described, it appears that you are experiencing a complex array of neurological and possibly musculoskeletal issues that may be interconnected. Given your history of polio and prolonged sitting, it is essential to consider various potential causes for your left-sided facial and scalp numbness, as well as the other symptoms you've mentioned.

1. Neurological Considerations: The numbness in your left cheek and scalp could be related to issues with the trigeminal nerve (cranial nerve V), which is responsible for sensation in the face. The fact that these symptoms have been intermittent over the past two to three years, and that they seem to worsen during specific times (like winter or during your menstrual cycle), suggests that there may be a component of nerve irritation or compression. Additionally, the left-sided drooping of your eye and face could indicate involvement of the facial nerve (cranial nerve VII), which may be affected by various conditions, including Bell's palsy or other neurological disorders.

2. Dental Issues: Your mention of an impacted wisdom tooth could also be relevant. Dental problems, especially those involving the lower jaw, can lead to referred pain or numbness in the facial region. If the wisdom tooth is causing pressure on nearby nerves, it could contribute to the symptoms you are experiencing. It would be prudent to have a dental evaluation to rule out any dental-related causes.

3. Musculoskeletal Factors: The chronic pain in your left shoulder and neck, along with the tendency to sleep on your left side, may indicate musculoskeletal strain or tension that could be contributing to your symptoms. Poor posture or prolonged sitting can lead to muscle tightness and nerve compression, which may exacerbate feelings of numbness or tingling.

4. Other Symptoms: The left eye watering, eyelid twitching, and the tremor in your left index finger could suggest a broader neurological issue. The twitching of the eyelid and lip may be related to stress or fatigue, but they can also be indicative of a neurological condition that warrants further investigation.

5. Recommended Actions: Given the complexity of your symptoms, it is advisable to consult with a neurologist for a comprehensive evaluation. They may recommend imaging studies, such as an MRI, to assess for any structural abnormalities in the brain or cervical spine that could be contributing to your symptoms. Additionally, a referral to an ear, nose, and throat (ENT) specialist may be beneficial, especially considering your nasal congestion and facial symptoms.

6. Potential Treatments: Treatment will depend on the underlying cause identified. If nerve compression or irritation is confirmed, physical therapy may help alleviate symptoms. If dental issues are found, addressing those may provide relief. In some cases, medications to manage nerve pain or inflammation may be prescribed.

In summary, your symptoms are multifaceted and could stem from a combination of neurological, dental, and musculoskeletal factors. A thorough evaluation by a neurologist, along with potential referrals to other specialists, will be crucial in determining the underlying cause and appropriate treatment plan. It is essential to address these symptoms promptly to prevent any potential progression or complications.

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