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Having irritation of the maxillary nerve, paresthesia in face. Noted DVA on MRI. What is the problem?

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hi, i have a question about trigeminal neuralgia. does a diagnosis always require "pain?" i have all the symptoms of irritation of the maxillary nerve, paresthesia throughout face in shock-like sensations that sound exactly like TN, but they are not painful. i also have a DVA noted on MRI
Posted Mon, 27 Aug 2012 in Brain and Spine
Answered by Dr. Pratap Sanchetee 6 hours later

Thanks for posting your query.

Rarely trigeminal neuralgia (TN) can be without overt pain. Such symptoms are usually seen as recurrence of TN after surgery, radiofrequency or local injection around nerve. In your case, none is applicable.

In all likely, your pain symptoms have been mixed up with shock like sensation. You should consult a neurologist for evaluation and treatment.

Please do write back for follow up queries that you may have.

Above answer was peer-reviewed by
Follow-up: Having irritation of the maxillary nerve, paresthesia in face. Noted DVA on MRI. What is the problem? 11 hours later
Thanks so much for your response. I have been experiencing these painless "shock-like" sensations that go from the right side of my face, around my lips, through my right arm to my fingertips (pinky) simultaneously, on and off for several years now and no one has a clue what's happening. I do have several issues with my cervical and lumbar spine, including several bone spurs, bulging discs, spondylosis and spinal stenosis from C4-C7, which would explain the paresthesias in my arms and legs, and bone spurs and spondylothesis in my L4. However, the doctor's can't seem to figure out why it would be affecting my face.

It follows the same pattern every time I experience issues like this: my neck will begin hurting out of nowhere, like a sore crick and stiff, after not hurting at all for several months. Once the pain subsides, I'll start experiencing these painless "shock-like" sensations throughout my face down my arms. They last for only a second or two and stun me, but they can sometimes happen repeatedly, non-stop like 100x per day. After a month or two it will go away for a few months, and then it follows the same process again. This has gone on since 2009. I am also hyper-reflexive, experience hand and neck tremors with difficulty controlling my head and involuntary spasms, bladder control issues, constant bruising all over my body all the time and I can't remember bumping into anything, continuous bouts of severe anemia, sudden irregular periods, all of which is probably unrelated but you never know.

I have had 2 brain MRIs, in 2009 without contrasts and one recently with and without. Both normal except for the venous anomaly noted in the recent one. The only thing I can figure out is that the DVA gets inflamed from my neck inflammation when it hurts, which would press on both my trigeminal nerve and my spinal cord at the same time. Is that even possible? I have only seen an orthopedic surgeon at this point who suspected MS, and have an appt with a neurologist in September. But the clean brain MRIs would eliminate MS right? All my doctors agree that something is going on, but no one can figure out WHAT is going frustrating.

Answered by Dr. Pratap Sanchetee 10 hours later

Well it is unlikely that you have MS in view of long duration of symptoms and normal MRI

Shock like sensation on right side face and right arm, hand and neck tremors with difficulty controlling head and involuntary spasms, suggest some problem at upper portion of cervical spinal cord. I am sure MRI of cervical spinal cord has been done and it is normal.

I think at this stage one must consider symptomatic and empirical treatment. Your doctor may consider carbamazepine, low dose anxiolytics and correction for anemia. You should try and overcome your frustration as it often aggravates symptoms.

Let me know if you have any more questions.

Dr. Pratap
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