Neurological Symptoms: Facial Numbness and Eye Pain Explained

Q: Neurological Symptoms: Facial Numbness and Eye Pain Explained

Hello, Miss： After reviewing your description, your condition seems to involve paroxysmal sensory and motor abnormalities on the left side of your face, along with frequent pauses in thought and expressive difficulties. <br>Possible clinical causes include： 1) Paroxysmal neurolog

Recently, I have been experiencing numbness on the left side of my face, eye pain, and numbness in my legs?

Previously diagnosed with migraine, left facial numbness, and left mouth corner twitching.
An MRI showed small white spots in the cerebellar region, and after consultation, it was deemed not serious.
After medication, there was no headache or numbness.
I was also taking a low dose of an anticonvulsant (Lamotrigine 1/2 tablet) for bipolar disorder from the psychiatry department, which I stopped on my own after two weeks.

On 12/16, I experienced interruptions in thought processes when faced with complex questions, and when I could think, my expression was fragmented.
On 12/17, a cold front hit, and I had persistent left facial numbness all day, along with weakness in my left hand for several minutes.
My left eye was painful.
On 12/18, the left facial numbness and left eye pain continued, with occasional numbness in my left foot.
After trying half a tablet of an emotional stabilizer (Anxiolytic), the facial numbness surprisingly eased.
(1) I am unsure if this is a precursor to a cerebrovascular accident (stroke), compressive neuropathy, or abnormal discharges due to stopping the anticonvulsant.
(2) Both the psychiatry and neurology departments advised me not to consult the other specialty.
However, the psychiatry department diagnosed me with bipolar disorder, while the neurology department attributed my migraines to depression.
The psychiatrist mentioned that the medications prescribed might overlap with those from the neurology department.
Could this overlap, combined with my decision to stop the medication, be the cause of my symptoms? Thank you, doctor.

momo, 40~49 year old female. Ask Date: 2015/12/18

Dr. Yang Shenggong reply Neurology

Hello, Miss: After reviewing your description, your condition seems to involve paroxysmal sensory and motor abnormalities on the left side of your face, along with frequent pauses in thought and expressive difficulties.
Possible clinical causes include: 1) Paroxysmal neurological dysfunction due to localized brain epilepsy: In this case, medications like Keppra or Lamictal may provide relief; 2) Transient ischemic attacks (TIAs): These can occur due to narrowed blood vessels or temporary ischemia in the brain, especially in the presence of multiple vascular risk factors (such as hypertension, diabetes, hyperlipidemia, heart disease, family history, obesity, etc.); 3) Migraine with transient neurological symptoms.
Additional notes: 1) The small white spots in the cerebellar region noted on your MRI do not explain your symptoms unless there are other brain lesions present; 2) Conditions triggered by cold weather or changes in weather could potentially relate to any of the three causes mentioned above, and it is advisable to discuss this with your physician; 3) If your condition is due to transient ischemia, it is essential to evaluate cardiovascular risk factors and correct any abnormalities.
Recommendations include staying hydrated, maintaining a low-fat, low-salt, low-sugar diet, and avoiding smoking or secondhand smoke; 4) Abnormal discharges after discontinuation of antiepileptic medication typically occur only in patients with epilepsy.
It is advisable to consult your neurologist to assess the need for further tests, such as an EEG or blood tests; 5) It is recommended to primarily consult a neurologist.
If no objective evidence of the aforementioned diseases is found, then a psychological evaluation and treatment can be pursued.
I hope this answers your questions.
If you have further inquiries, you may visit our hospital for additional consultation, where you can receive more diagnostic information.
Wishing you a speedy recovery and better control of your condition.

Reply Date: 2015/12/18

More Info

Your symptoms of facial numbness, eye pain, and the history of headaches raise several important considerations regarding potential neurological conditions. Given your previous diagnoses and the current symptoms, it is crucial to approach this situation with a comprehensive understanding of the possible underlying issues.

Firstly, the combination of left-sided facial numbness, left eye pain, and episodes of weakness in your left hand could suggest several neurological conditions. While you mentioned that MRI results showed small white spots in the cerebellum, which were deemed not significant, it is essential to consider that these findings can sometimes be indicative of underlying conditions, such as multiple sclerosis (MS) or small vessel disease, especially if they are accompanied by neurological symptoms.

1. Stroke or Transient Ischemic Attack (TIA): Your concern about a potential stroke is valid, especially given the acute nature of your symptoms. Strokes can present with sudden numbness or weakness on one side of the body, facial drooping, and difficulty speaking. However, your symptoms appear to have fluctuated and improved with medication, which may suggest a less acute process. A TIA, often referred to as a "mini-stroke," can cause similar symptoms but typically resolves within 24 hours. Given that your symptoms have persisted and improved with medication, a stroke may be less likely, but it should not be entirely ruled out without further evaluation.

2. Nerve Compression or Inflammation: The symptoms you describe could also be related to nerve compression or inflammation, such as trigeminal neuralgia or a form of neuropathy. The left-sided facial numbness and pain could indicate irritation of the trigeminal nerve, which is responsible for sensation in the face. This condition can be exacerbated by stress or changes in medication, particularly if you have recently stopped taking an anticonvulsant medication.

3. Medication Withdrawal Effects: Stopping your anticonvulsant medication abruptly could lead to withdrawal symptoms, which may include increased anxiety, mood swings, and neurological symptoms. The fact that you noticed some relief in your facial numbness after taking a small dose of your mood-stabilizing medication suggests that your symptoms may be influenced by your mental health condition. It is not uncommon for mood disorders to manifest with physical symptoms, including headaches and facial pain.

4. Psychogenic Factors: Given your history of bipolar disorder and anxiety, it is also important to consider the role of psychological factors in your symptoms. Stress and anxiety can lead to physical manifestations, including tension headaches and facial discomfort. The interplay between your mental health and neurological symptoms can complicate the clinical picture, making it essential to address both aspects in your treatment plan.

In conclusion, while your symptoms could potentially indicate a serious condition such as a stroke or nerve compression, the fluctuating nature of your symptoms and their response to medication suggest a more complex interplay of neurological and psychological factors. It is crucial to maintain open communication with both your neurologist and psychiatrist to ensure a coordinated approach to your treatment. If your symptoms persist or worsen, further imaging studies or referrals to specialists may be necessary to rule out any serious underlying conditions. Always prioritize your health and seek immediate medical attention if you experience new or worsening symptoms.

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