Q. Are these symptoms connected with Brainstem Lesions?

Answered by
Dr. J Mariano Anto Bruno Mascarenhas
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 24, 2017

Hi Doctor,

Around eight months back, I had a strange numb feeling in my nose. I ignored it because I had three abscessed tooth on my left side and I thought the numbness was due to that.

It gradually went away and I forgot about it. Last month, my daughter fell sick and I was going through some extreme stress. I started getting the numb feeling again and now it is up to my left temple. There is a pressure from my nose to the left temple with numbness and sometimes tingling. Then suddenly a tinnitus set in my left ear, a loud high pitch. Also, I had a strange burning tongue symptom.

I got scared and went to an ENT. He took a hearing test and told me that I did not have any hearing loss. He blamed it all on my abscessed tooth and said to go to the dentist. I have got all the three teeth pulled out. I was given intravenous and local anesthesia as well during the process. After recovery the tinnitus has not gone away and the sensations are becoming worse and weird day by day.

My problems are as follows:

  • Numb sensation in my nose to my left temple,
  • tenderness of the scalp,
  • burning on the left side of my mouth and tongue,
  • dull pain on my face,
  • very sensitive to touch and the same in both ears,
  • jaw seems still a bit inflamed,
  • strange itching sensation on my face, eyes, legs, arms, etc.,
  • strange pressure in the ears,
  • shakiness,
  • chilly feeling and weak legs and arms at times, especially at night and the pain in my neck and shoulders.

Tooth healing has gone well. These symptoms are weird and appear on and off.

I am confused. My doctor says that I got anxiety, but I am feeling these physical symptoms. My neurologist has told that my MRI is normal. He also ran a test to rule out carpal tunnel and nerve function in my hands and legs. One of my legs has reduced sensitivity. He has prescribed me some medicines and I am not happy with his approach. I am really scared of these symptoms. Please help.

#

Hi,

Welcome to icliniq.com.

I have read your question with care and understand your problems.

All your symptoms can occur in brainstem lesions. Many lesions in the early stages may not be identified by routine MRI sequences.

You have to do the following tests:

  1. MRI - Diffusion and ADC (apparent diffusion coefficient).
  2. MR tractography.
  3. PET scan to find the metabolism of the brainstem.

The symptoms you have narrated can also occur if there is reduced blood flow to the brainstem. This condition is called as vertebrobasilar insufficiency. This may be detected by CT angiography of brain, MRI angiography of brain and DSA (digital subtraction angiography).

Also, the symptoms you have told can occur as a part of a systemic problem like low blood pressure and anemia.

Low blood pressure (hypotension) can be checked by measuring your BP and anemia can be confirmed by checking your blood hemoglobin levels.


The Probable causes:

1. Brainstem lesions.
2. Vertebrobasilar insufficiency.
3. Low blood pressure.
4. Anemia.

Investigations to be done:

1. BP check.
2. Blood hemoglobin.
3. CT angiography of brain.
4. MRI - Diffusion and ADC.
5. MR tractography.
6. MRI angiography of brain.
7. PET scan to find the metabolism of the brainstem .
8. DSA.

Regarding follow up:

Revert back with the reports to a neurologist online.---> https://www.icliniq.com/ask-a-doctor-online/neurologist


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