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What causes numbness of jaw and wrist and migraine?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Hi. I am a 43 year old otherwise healthy woman. Have had mild hypertension, but it has been controlled from the moment it hit 130/90 ten years ago. I also was diagnosed with migraine two years ago after a terrible headache that began after attempting to take birth control pills for irregular bleeding. At that time an MRI & MRA (no contrast) was done, as my mother had a berry aneurysm when she was 32. The summary came back normal with the exception of "few FLAIR/T2 hyperintenssities." "Few" was not quantified on the summary. In any case, I started having unusual symptoms about 4 weeks ago that started with a breathing abnormality. I would wake up with a feeling of vertigo and like a spasm or hiccup in my breathing. I do not have trouble "re-catching" my breath, but it does start and unsettle me. Then it started happening during the daytime. Nonetheless, I went to a sleep specialist and results are pending next week from a sleep study. I'm 135 pounds and 5'4" and while I have been told I don't fit the body type for apnea, I wanted to rule it in or out. (Note: As I was gathering my things the sleep tech said, "Wow. Your legs wake you up about every minute!" No other comments from her.) I had two ER visits with these breathing episodes. The first time I checked out normal with a clear chest x-ray, EKG, and blood work. The second time I was extremely light headed (one week later) and my breathing was becoming a real problem. I couldn't speak at times when I was asked questions. (No air) My BP reached 177/122 (which it NEVER EVER does) my EG was irregular with sinus tachycardia (orthostatic hypertension- from 100 bpm sitting to 140 standing). I also had pressure in the left side of my neck. I followed up with a cardiologist and am not on Metopropol 12.5 bid. No other medicines except Imitrex and Zofran for the occasional migraine. ECHO and holtor in the next couple weeks.

Those were not the "weird" symptoms in my mind. A few days prior to that ER encounter, my left thumb and finger and wrist went numb. Then my lower left jaw, tongue, and up to my left nostril went numb, as though I had just returned from dental work. When I went to swallow my soup, it felt as though my swallowing was uncoordinated. (The swallowing quickly returned to normal, but the numbness remained.) A neurologist ordered a MRI with contrast to explore MS. It returned with 7-8 T2 hyperintensities (nonspecific) in various areas, but he said they don't "light up" on the images with contrast. I also have started having issues when I pick up cold (iced) glasses, as it hurts a bit. I have had issues with the bottom of my left foot being painful when I walk, though this has improved. So the neurologist has told me that this MRI was not normal, but that he does not recommend the spinal tap because even if I do have MS, only 2% or so of people actually show up positive on this test. He said we hould just wait a year and repeat the MRI. He said there is some eye test that he finds worthless too. So, would you advise a second opinion by a MS specialist or is this advise a good as it gets? I just want these symptoms to stop.
Posted Tue, 19 Aug 2014 in Headache and Migraines
 
 
Answered by Dr. Sudhir Kumar 21 minutes later
Brief Answer:
Would agree that it does not sound like MS

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted the detailed description of your symptoms and past history.

I agree that your symptoms and MRI brain findings do not suggest a diagnosis of multiple sclerosis (MS) and as of now, you do not need to see a MS specialist for second opinion.

A clinical episode in MS should last for at least 24 hours, however, in your case, it seems to have improved quite fast.

Also, the MRI in a case of MS should show lesions of varying ages, and a few should enhance with contrast (which indicate an active MS disease).

Also, there is no need to do the visual evoked potential (VEP, eye test) and spinal tap (to look for oligoclonal bands) as the chances of them coming positive in absence of typical MRI lesions are very low.

Your symptoms and MRI lesions could be related to migraines. However, we also need to exclude ischemia (lack of blood supply to brain) in view of history of high blood pressure. Please discuss about this possibility with your doctor.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

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