LESIONS

A Guide to Localisation in Neurology

Case 3. Numb face

Case

A 32 year old woman presented with numbness and tingling in the left half of her face. She became aware of this while removing make-up. The feeling was similar to the after-effects of a dental anaesthetic when wearing off.

On touching her face, she felt sensory disturbance from the top of the scalp down to the chin, but not involving the neck below the jawline – she could still feel her touch, but it felt reduced in intensity compared to how it should have felt, and in comparison to the intact right side. The lip and inside of the oral cavity also felt strange, and when brushing her teeth she could not tell how hard she was brushing and had made her gums bleed once.

The following were normal: taste, smell, vision, hearing, chewing and swallowing, speech, facial movements. She had no symptoms in the limbs, nor headache. She reported no dry mouth, dry eyes or issues with tear production. She had been well in the run-up to this.

The numbness was getting more intense over the 3 days from onset, which prompted her to see her doctor.

She had no prior medical history.

On examination she had:

• reduced touch sensation (i.e. hypoaesthesia) in the left half of the face, including the scalp and forehead, cheek and chin, compared to the right which was normal.
• absent pinprick sensation in the same areas – she felt the pin contacting the fact, but it didn’t feel sharp (i.e. analgesia)
• An absent corneal blink reflex on the left (neither eye blinked). On testing the right cornea, both eyes blinked.

The rest of the exam was normal, including other cranial nerves. There were no sensory changes over the neck, occiput or anywhere else.