Neurology
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Answered in 23 minutes by:
4/10/2012
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9,000
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
VerifiedHI. Hard to help this question without an exam. But this is what I can tell you. I assume he is right handed, I would need to know which arm went numb. Specifically when the lips and arm go numb, associated with speech dysfunction (sounds like an expressive or transcortical motor aphasia), coming on suddenly, it localizes to the dominant hemisphere opercular/medial temporal/frontal area along the homunculus (look it up). The MRI is obviously the first thing to do, and anything funny on MR need gadolinium enhancement. The tooth pain/infection, if its in the lower jaw, could affect the carotid artery (unlikely) but carotid artery dissection is the most common reason for a stroke like attack in a person your brother's age. But look dominant hemisphere, mesial temporal. IF you don't see anything, he needs an EEG. Herpes encephalitis is in the differential, but unlikely unless he's much sicker.
Hi. You would expect the right arm and maybe right side of the face as well as speech to be localized to the Left Hemisphere, left middle cerebral artery, in at least 85% of patients. So it all points to the Left MCA distribution. Is he hypertensive, family history of cerebral aneurysm?, again, if the MRI is negative, he needs the EEG and maybe a lumbar puncture. If he gets that, make sure you check oligoclonal bands, IgG index, but this does not sound like MS. There is a condition call Transient Global Amnesia, or TGA, so someone should check with him later regarding his memory of the event. This type of symptoms are almost classic for herpes encephalitis, so again he would need the spinal tap. Hope that helps.
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9,000
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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