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Dr. Andrew Rynne
Dr. Andrew Rynne

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What causes dizziness, nausea, vomiting and facial paralysis?

Answered by
Dr. Olsi Taka


Practicing since :2004

Answered : 3650 Questions

Posted on Thu, 5 May 2016 in Brain and Spine
Question: I believe I had a stroke last July. I was suddenly nauseous and could not stand due to dizziness. I began vomiting uncontrollably and an immediate warm sensation. this lasted about 45 minutes, at which point I went to sleep. I woke the next day to find the right side of my face (eye, mouth and forehead) paralyzed. The facial paralysis lasted about 8 weeks but I have not fully recovered. I would say I;m about 90% recovered facial nerves.
But soon afterward I noticed a lump on the back of my neck below the skin about even with my ear lobe. It moves as I move my head side to side. My symptoms are an abnormal, electric type of feeling in my head and my right ear rings with my heart beat, but some times a solid ringing. I also have vision problems. Not exactly double vision but trouble reading.
Answered by Dr. Olsi Taka 59 minutes later
Brief Answer:
Bell's palsy, stroke unlikely

Detailed Answer:
I read your question carefully and I understand your concern.

After considering all your symptoms and the sequence of events though I do not believe that you have had a stroke. A stroke doesn't limit itself to the face, it generally involves the limbs as well, at least the upper one who is closer to the brain area for the face. Also when the facial paralysis is due to stroke it doesn't involve the whole face, only the lower half sparing the forehead unlike your case. So that description is more compatible with peripheral nerve palsy, otherwise called Bell's palsy. It can have many different causes, but the overwhelming majority remains without a detectable cause, hypothesis speak of some viral infection playing a role, but nothing proven.

As for the ringing in the ear and the preceding vomiting episode they can accompany Bell's palsy as well, particularly the ringing. That is because of the facial nerve controlling the stapedius muscle inside your ear which is involved in sound conduction, so its paralysis may cause acoustic symptoms.

Now the remaining issues....the lump I do not think has much to do with any of it. Brain conditions (even if you had one) are confined by the skull do not cause lumps in the surface. It might be some benign skin gland tumor or an enlarged lymph node, anyway not related to the facial palsy.
As for the vision problems, it is hard to express an opinion since you are not very specific. If the ophthalmologist doesn't find anything with your eyes, perhaps a brain MRI might be scheduled. That should be done not for stroke which as I said I consider unlikely, but for some other inflammatory condition, which might cause separate lesion like multiple sclerosis which can be a rare cause of Bell's palsy and of vision issues as well.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 34 minutes later
Thanks for your reply. I have read much about Bell's Palsy as I at first thought that was what it was. And yes, according to what I've read, most stroke cases also involve limbs and extremities and not the forehead. That being said, I have also read that these may not necessarily be mutually inclusive or exclusive, and a stroke may not effect the limbs and extremities, based on severity of the episode.

Just to clarify, the paralysis was on the right side of my face only and included the inability to close my right eye, furrow my brow, etc.

Typically Bell's Palsy is not accompanied by any symptoms leading up to it. In fact, all I've researched suggests that most people just wake up and have it,

This is what confuses me as to what I should do, as I have no insurance. Also, in the couple of months leading up to that night, I had been experiencing spells of lightheadedness. these would occur whether I was standing, sitting or even walking.

I have considered that I may have a brain stem or upper spinal cord tumor? It hasn't grown or shrunk since I noticed it in August. I have otherwise been healthy all my life and have had no illnesses. Is this a legitimate concern?

I understand that the tinnitus and other symptoms I have can be Bell's Palsy but it can be many other things, a brain stem tumor being one that shares many of those symptoms. The difference is the lump and the fact that, in my otherwise great health, I should be clear of Bell's Palsy symptoms by now.

To be more specific, the lump is in the center back of my neck, below the skin, and about one inch below where the skull ends. And it is hard to the touch, not soft. Thanks again,
Answered by Dr. Olsi Taka 27 minutes later
Brief Answer:
Read below.

Detailed Answer:
It seems that the feature you are more concerned about is the lump, but really it shouldn't, at least not in the sense of it being a brain stem tumor. I must repeat that the brainstem is inside the thick bony skull vault, whether you have a brainstem tumor or not it doesn't show on the surface at all. The spinal cord as well is inside the bony vertebral column, its tumors do not protrude under the skin either. So again you can be 100% sure that that lump is not a brainstem or a spinal tumor. As I said may be a benign tumor such as a lipoma or an atheroma, or an enlarged lymph node. Visual inspection and palpation is needed to be more precise, at times a biopsy.
As for having a brainstem tumor not related to the lump it is not likely especially not after this long time. A tumor is a progressively growing mass and as such its manifestations increase gradually. It does not cause a sudden severe facial palsy overnight then get partially better by itself. I can not really explain the lightheadedness episodes in the months preceding the facial palsy, but lightheadedness may have many causes, many nonneurological, anyway the fact they haven't progressed since speaks against a tumor.
As for being clear of Bell's palsy symptoms, while it is true that young healthy people recover better, in a percentage of case some permanent deficit may remain. The more severe the initial state the higher the risk of that and from what you have described, yours was a severe facial palsy case.

Whether it is theoretically possible that a stroke affects only the face, causing a complete facial palsy like that you describe, theoretically it could be....but put yourself in my position, why should I (and you) believe you have this unique case which is possible in theory but I have never seen in 8 years dealing with stroke patients, instead of facial palsy which is a common condition causing such symptoms. And that in a 47 year old person, an unlikely young age for stroke.
I mean an MRI might prove me wrong, that's why we have exams to confirm our suspicions, but as I am judging by your clinical history for now, I must stick with what is by far the more likely cause. As I said even if I requested an MRI (do not think it absolutely necessary considering you do not have insurance) I would do it to rule out MS not stroke.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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