Brief Answer:
Tingling sign DD and need more information to rule out stroke possibility

Detailed Answer:
Hi xxxxxxxx, thanks for asking from HCM.


I can understand your concern. You are having intermittent episode of tingling sensations left side skull, near ear. Such kind of symptoms can be due to

- Ear pathology like otitis externa, local infection.

- Occipital neuralgia left side

- Migraine

- Left side neck muscle spasm

To confirm the aetiology, you should consult ENT specialist to rule out local ear pathology. If ear is normal, then consult neurologist to rule out migraine/spasm or neuralgia. I will describe each in brief. you can correlate your features

- Occipital neuralgia presents as brief episodes of current like pain/tingling sensations over occiput region till ear. It occurs on one side only and pain increases on flexing neck.

- Spasm can present with tingling, dull pain and local tenderness of neck muscle. Pain increases on moving neck or stretching muscle or giving pressure.

- Migraine usually present with one side headache, throbbing type, along with eye pain, photophobia, watering in eyes, tingling sensations on same side of body, occurs in episodes.

There is possibility that you are having subtle signs only. So making diagnosis might require complete evaluation and few investigations. Thats why neurologist consultation is needed.

You are worried about stroke possibility. Such symptom is usually not seen in stroke or transient ischemic attack (precursor of stroke). To rule out stroke possibility in future, I need more information about you

- Do you any history of diabetes or cardiac illness?

- Did you get your lipid profile done? If yes, was there any raised cholesterol level or triglyceride level?

- Is there any history of sudden dizziness, vertigo, focal weakness of short duration? These features can be seen in "transient ischemic attack". It can cause stroke later on.

- Is there any history of MRI brain and angiography?

Kindly provide me answers of above questions. I will help you in ruling out stroke.

Hope it will help. If any doubt, do let me know. Thanks. Take care.

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Brief Answer:
Need MR Angiography or doppler study to rule out stroke

Detailed Answer:
Hi xxxxxxxxxxxx, welcome back.


Thanks for providing me detailed history and answers of my questions. You are having few risk factors for stroke which are raised triglycerides, age, mild diabetes. To rule out future possibility of stroke, we need evaluation of your brain vessels. A plain CT scan is a screening test which can not tell about vessels status. So we can not decide based on its report. You need

- MRI brain and angiography
or
- Ultrasound doppler neck vessels.

MRI brain is better than doppler except it is more costly and time consuming.

The tingling sensations, after your detailed history, seems to be due to sudden change in posture which might be causing decrease in blood flow to brain or causing mild pressure over sensory nerve. There is an entity "micturition syncope" which can occur in diabetics. In it, there is dizziness/tingling and loss of consciousness while patient goes for micturition. You don't have that full fledged diabetes and no such kind of history. So chances of it is minimal.

But you are experiencing some tingling, evaluation by neurologist is needed to know about sensory nerve involvement or transient ischemic attack. The term "TIF", I think you want to say "TIA (transient ischemic attack".

Do let me know about MR angio or doppler study. It will help me in reaching at some conclusion.

Hope it will help. If any doubt, do let me know.
Thanks. Take care.

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