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Having facial numbness, numb at base of skull and crawling sensation. MRI scan showed Cerebral volume loss. What to do?

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Posted on Fri, 26 Jul 2013
Question: My Mother a 70 yo healthy ,active lifestyle female has been having symptoms on and off for 6 years. She was just recently hospitalized last weekend. Her symptoms were: L-facial numbness,numb at base of skull , L-ear plugged, L-side facial "crawling sensation" and unbalanced gait on left side ,vision sensation distorted (as out of body like) CT scan neg, chest x-ray showed Mild COPD,Carotid neg. MRA of head neg, labs all WNL,echocardio 60%EF, MRI brain s contrast showed :
1. No acute intracranial process
2. Cerebral volume loss and suspected patchy microvascular ischemic changes throughtout white matter.
She is symptomatic daily it is interfering with her ADL's.

Cholesterol normal, Medication: Metoprolol and Avalide for Blood pressure otherwise healthy, she has a history of low thyroid but not on meds due to ok lab values as of 2 years ago. She also was on ASA but stopped non relative
doctor
Answered by Dr. Luchuo Engelbert Bain (1 hour later)
Hi and thanks for the query,

The symptoms described are very compatible reduced blood flow to certain regions of the brain. Microvascular ischeamic changes are changes resulting in reduction the sizes of the lumen of the blood vessels reducing blood vessel permeability and blood flow. major risk factors are hypertension and blood lipid level abnormalities. your mum is hypertensive but is ok with respect to lipids.

With age, a decreased brain size is but normal. The sensations she is experiencing are probably due to the microcvascular changes. Changes in gait imply the part of the brain controlling gait has been touched, the cerebellum.

Treatment in this case requires adequate blood pressure control, use of low dose Aspirin. Life style changes like remaining active, adopting a vegetable XXXXXXX and fruit XXXXXXX diet, low salt intake and low saturated fats are advisable.

An evaluation by a neurologist could be very useful. Specific brain lesions, including screening for some electrolyte abnormalities (Calcium, Magnesium) could be necessary. Vitamins are strongly advised under such circumstances. however, booking an appointment with a neurologist is very important. For now, no worries. feel free asking any specific questions if need be.

Thanks for now and kind regards.

Bain LE, MD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Luchuo Engelbert Bain (3 hours later)
All labs were normal her Vitb was low for a year she was getting injections now it is normal range. Could this be caused by deficiency of b12 over time. And if yes is it permanent?
doctor
Answered by Dr. Luchuo Engelbert Bain (3 hours later)
Hi and thanks for the query,

Vitamin B12 deficiency could not be incriminated as a direct cause, but as an AGGRAVATING factor. Controlling or normalizing Vitamin B12 deficiency through active supplementation could b very useful. Remember that it could take up to 6 months while on Vitamin B12 for its actual impact to be felt. Reason why long term treatment is advised and not to stop after taking it for a few weeks or a month.

The opinion of a neurologist for a careful review however still stands out to me to be of utmost importance. I suggest she continues with her Vitamins as she waits to see her doctor. Other treatment options do exist that could also be of great help (low dose Aspirin, BP control, above cited life style changes, Calcium Magnesium Supplementation if needed, Trimetazidine, Citicoline, a neuroprotector). Prescription however depends on a sound appraisal of past medical history and a good physical and neurological exam.

Thanks once again and hope this helps. Waiting to contribute any ideas if you deem necessary. Feel free to contact me. Kind regards.

Bain LE, MD.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Luchuo Engelbert Bain

General & Family Physician

Practicing since :2009

Answered : 3092 Questions

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Having facial numbness, numb at base of skull and crawling sensation. MRI scan showed Cerebral volume loss. What to do?

Hi and thanks for the query,

The symptoms described are very compatible reduced blood flow to certain regions of the brain. Microvascular ischeamic changes are changes resulting in reduction the sizes of the lumen of the blood vessels reducing blood vessel permeability and blood flow. major risk factors are hypertension and blood lipid level abnormalities. your mum is hypertensive but is ok with respect to lipids.

With age, a decreased brain size is but normal. The sensations she is experiencing are probably due to the microcvascular changes. Changes in gait imply the part of the brain controlling gait has been touched, the cerebellum.

Treatment in this case requires adequate blood pressure control, use of low dose Aspirin. Life style changes like remaining active, adopting a vegetable XXXXXXX and fruit XXXXXXX diet, low salt intake and low saturated fats are advisable.

An evaluation by a neurologist could be very useful. Specific brain lesions, including screening for some electrolyte abnormalities (Calcium, Magnesium) could be necessary. Vitamins are strongly advised under such circumstances. however, booking an appointment with a neurologist is very important. For now, no worries. feel free asking any specific questions if need be.

Thanks for now and kind regards.

Bain LE, MD.