1017 — Journal of Neurology, Neurosurgery & Psychiatry

1017 -- Journal of Neurology, Neurosurgery & Psychiatry

Paresthesias may be due to conditions that affect sensory function at the level of the peripheral nerve or, less commonly, at the level of the dorsal root ganglion, dorsal sensory nerve roots, spinal cord, or brain. It doesn’t matter if you have the virus or not; you should be concerned about it. Lumbar puncture (LP) showed white blood cells 30/µL (87% lymphs), red blood cells 3/µL, protein 68 mg/dL, glucose 49 mg/dL, and a negative Gram stain and bacterial culture. Why: e.g. broken leg or foot may damage nerves and cause leg paresthesia; whiplash injury; Brachial plexus injury; finger injury, hand injury; facial bone fractures including fracture of the zygomatic and orbital bones (bones of the face) may cause paresthesia of the upper lip. He has it all the time for the past three weeks it does not come and go and it affects his tasting since his tongue is always numb. Neurological examination showed anisocoria, peripheral right sided facial paresis, reduced sense of taste on the right half of the tongue, and dysaesthesia in the region of the second segment of the right trigeminal nerve.

1017 -- Journal of Neurology, Neurosurgery & Psychiatry
Tingling face, a feeling of “pins and needles” in your face, can have many causes. A 26 year old man presented with a 3 day history of facial asymmetry and right sided numbness of the face and tongue. facial palsy Bell’s palsy, cranial mononeuropathy VII, facial mononeuropathy, facial nerve palsy, facial neuralgia Neurology Acute peripheral paralysis of the face due to a herpes simplex immune-mediated condition often characterized by severe pain in the trigeminal nerve Epidemiology Risk of FP ↑ with age; age 10 to 19, 2:1, ♀:♂; age 40, 3:2, ♂:♀; pregnant ♀ have 3.3 times ↑ risk than nonpregnant; DM = 4.5 times↑ risk of FP; 10% of Pts have positive family Hx of FP Pathogenesis FP is due to reactivation of the virus leading to replication of virus within the ganglion cells; the virus travels down the axons, inducing inflammation Clinical Abrupt onset, drooping mouth, unblinking eye, twisted nose, uneven smile, distorted expressions; paralysis hits maximum in 1 to 14 days; retroauricular pain, facial numbness, epiphora, parageusia, ↓ tearing, hyperacusis, hypoesthesia or dysesthesia of cranial nerves–CN V and IX, motor paresis of CN IX and X, papillitis of tongue DiffDx, unilateral Tumors or masses, otitis media, sarcoid, Lyme disease, skull fracture, facial injury DiffDx, bilateral Guillain-Barré syndrome, Melkersson-Rosenthal syndrome, Möbius syndrome, motor neuron disease, myasthenia gravis Etiology Trauma, Bell’s palsy, stroke, parotid tumors, intracranial tumors Management Microvascular and micro-neurosurgical tissue transfers allow restoration of functional, unconscious, symmetrical facial movements, acyclovir, steroids–efficacy is uncertain, artificial tears, neuromuscular retraining–eg, mirror/visual feedback, biofeedback or electromyography feedback Prognosis 60 to 80% recover, especially if incomplete paralysis, and Pt is youngfa·cial pa·ral·y·sis (fā’shăl păr-al’i-sis) Paresis or paralysis of the facial muscles, usually unilateral, due to either a lesion involving the nucleus of the facial nerve or a supranuclear lesion in the cerebrum or upper brainstem. On sensory examination, he indicated a change of pinprick as well as temperature sensation in the right half of his face and mouth. Several forms exist that are classified according to symptoms. Next is referred to as the prodrome or the tingling phase. A, Axial T1 sequence with gadolinium contrast 30 months after initial presentation showing leptomeningeal enhancement along the ventral surface of both the cerebral peduncles (arrow).

Other conditions to consider are brachial plexus neuropathy, thoracic outlet syndrome, cervical rib, Pancoast’s tumour, Raynaud’s disease, sympathetic dystrophy or various entrapment syndromes such as carpal tunnel syndrome and ulnar nerve entrapment at the elbow. Why: may suggest a type of brachial plexus; compression of the C8 segment by cervical spondylosis or a disc herniation, median or ulnar nerve lesions; diabetes mellitus causing a peripheral neuropathy. Right lower corner shows the pons, fourth ventricle, middle cerebellar peduncle, and part of the cerebellum; left upper corner shows temporal bone and masticatory muscles. A strongly positive anti-extranuclear antigen (ENA)/SS-A antibodies test was shown on further investigation, with negative tests for antinuclear factor/anti-nDNA antibodies/rheumatoid factor and RNP/SS-B/Sm antibodies. I have had tingling and pain on my right side of my face. Anatomical illustration of the greater superficial petrosal nerve (GSPN) (black arrowheads). The GSPN can be followed from the geniculate ganglion of the facial nerve (white arrow) to the sphenopalatine ganglion (black arrow).

Connecting branches (white arrowheads) between the maxillary nerve (double white arrowhead) and the sphenopalatine ganglion link the seventh and fifth cranial nerves at this site. The pathophysiology is complex and includes oxidative and nitrosative stress, redox imbalance, endothelial dysfunction, perturbations in prostaglandin metabolism, and direct hypoxia and ischemia of nerve trunks and ganglia.

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