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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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tingling on the left side, face, arm, mild in leg,

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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Posted on Thu, 4 Apr 2019 in Brain and Spine
Question: tingling on the left side, face, arm, mild in leg, right side normal.
no loss of sensation. this has occurred for several days and seems to be getting stronger, does not appear to be related to activity as it occurs at night as well.

Ihave a mild hypertension which is being treated with metoprolol 25 mg 2x daily. also take tolterodine tartrate 4 mg daily as well as 81 mg asprin
doctor
Answered by Dr. Dariush Saghafi 50 minutes later
Brief Answer:
Think of vascular supply deficiency in the brain or metabolic issues

Detailed Answer:
Your symptoms could be initially taken to be those consistent with a form of vascular deficiency to the brain, over the right side although ongoing symptoms for 3 days without progression is highly unusual. Notwithstanding, my immediate recommendation is to be neurologically examined by a doctor in an Emergency Room setting so that in CASE this turns out to be a subacute mild vascular obstruction that at least you would be in an appropriate environment to initiate a full workup and in the event necessary you would be under surveillance in a tertiary care institution rather than risking be outside and having to then, race to get to a hospital if something catastrophic would happen.

If your symptoms were entirely restricted to the face then, my concern for vascular deficiency in the brain would not be quite as important and I might think about something such as BELL'S PALSY, diabetic neuropathy, or other nutritional deficiency syndrome, however, because the leg is also involved well,....that is why I am recommending you be seen as soon as possible....especially since you note symptoms getting more noticeable and staying restricted to the same region of the head.

Therefore, if you were in front of me in an ER setting and this had been going on for several days already I would do the following:

1. SOLID NEUROLOGICAL EXAMINATION to detect any subtle left sided weakness of the face, arm, or leg along with more subtle sensory losses (especially cortical sensory modalities such as graphesthesia, 2 point discrimination, and being able to recognize objects in the left hand without seeing them)

2. MRI and MRA of the brain and the neck. I (as a neurologist) would be very partial of getting this study done WITH PERFUSION AND DIFFUSION weighted imaging but in an ER they may not do more than a CT of the head (not very satisfying to me for your symptoms...but it depends on the degree of suspcion the ER doc has for this to be neurovascular in nature). I would at least get a CTA of the neck vessels to see what the right carotid system looks like. I'd also get an EKG (12 lead) and look for atrial fibrillation.

3. I would order a full metabolic panel of studies to include ELECTROLYTES, URINALYSIS, HbA1C, VIT. B12, FOLATE, VIT. D, FIBRIN, FIBRINOGEN, D-DIMER, AND FIBRIN SPLIT PRODUCTS. I'd run an ESR and C-reactive protein

4. I might also consider taking you off the aspirin and placing you on something such as PLAVIX (clopidogrel).

5. If within 24 more hours and after this type of workup as well as neurologist's intervention and blessing that nothing were up....then, I'd feel more comfortable letting you go back home....but with symptoms feeling more intense I'd be concerned that you'd be better off in a higher level of care for the time being rather than either at home or waiting for an appointment with a local neurologist.

If I've provided useful or helpful information to your questions could you do me the utmost of favors in not forgetting to close the query along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.

This query required 44 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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