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Currently experiencing numbness of the Lt. Side of my face…

Currently experiencing numbness of the...
Currently experiencing numbness of the Lt. Side of my face and tongue. Had Type A&B influenza on 3/13/2018. (very ill) Took 5 days of Tamiflu. Developed Sinusitis/Bronchitis. Finished Zpack yesterday. Nasal drainage remains purulent, very foul smelling sputum is now clear. Taking Guaifenesin with Phenylephrine q 4 hours. Nettie pot saline irrigation daily.No fever, intermittent chills. What is causing this facial numbness. Face is symmetrical. I have had Bell’s Palsy in the past - related to stress- took Valcyclovir. I have had intermittent hemiplegic migraines (Rt side) for the past 2-3 days. Should I take Valcyclovir again & should I be on a antibiotic with gram negative coverage?
Thank you.
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Answered in 37 minutes by:
3/22/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,125
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi Margaret, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health as you have described above. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

First of all about the numbness on the left side of the face and tongue regions; please see bell’s palsy typically presents with motor symptoms such as facial palsy, if you are not having any facial muscle weakness/palsy rather numbness is the only symptom then it does not appear secondary to bell’s palsy

I see you also have a history of migraine, so this left sided numbness could be due to migraine too

Based on the description provided by you it appears your migraine affects the right side, in the form of hemiplegic attacks, so the left sided symptoms appear new, but this could be a change in migraine pattern

Generally the migraine presents with same or similar symptoms each time for the same patient, with symptoms occurring in the same regions too - so migraine maintains its pattern, but rarely migraine can change the pattern, so it is possible the left sided numbness is due to migraine rather than something else, so it is possible this is a new pattern of migraine in your case.

And as mentioned above bell’s palsy should present with facial palsy

If your previous bell’s palsy started with numbness symp***** *****ke this then it is still a possibility, but if numbness was not associated with your previous bell’s palsy attack then there is no reason to suspect bell’s palsy in you now because you are having just sensory symptoms but bell’s palsy is typically associated with motor symptoms rather than any sensory symptoms such as numbness etc

Also we need to explore this further to find out any other possible explanations to this new onset numbness on the left side – which I have discussed again later

To your question, “Should I take Valacyclovir again?” please see as mentioned above there is no sufficient evidence for bell’s palsy in you, except - if this is how your previous bell’s palsy had started with numbness - otherwise numbness is not considered as a typical bell’s palsy symptom

To your other question- “should I be on a antibiotic with gram negative coverage?” yes, it appears gram negative coverage is necessary with antibiotics such as Augmentin or Cephalosporins or Quinolone group of antibiotics now since you have used Zpack which gives predominantly gram positive coverage but your symptoms are still persisting, and also to consider adding anaerobic coverage too through use of antibiotics such as Clindamycin or Metronidazole etc because the very foul smelling purulent drainage or sputum also raises suspicion for anaerobic infection too.

Considering this is new onset numbness it is better if you could visit the nearest ER, so that you can receive a thorough neurological examination followed by certain relevant investigations that may include an MRI scan of the brain and any other investigations as necessary and then treated appropriately depending upon the investigations, and also in the er they can decide on whether starting antiviral agents such as Valacyclovir for possible bell’s palsy is required or not, and also they can start antibiotics with gram negative & anaerobic coverage too so that this infection will receive appropriate treatments. One or otherway it does not appear there is any serious health issues going on, these health issues can be diagnosed and successfully treated & cured, so please not to be scared.

Wishing & reassuring you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 1 month ago
Thank you. I will see my MD tomorrow. Yes, my Bell’s palsy definitely had motor symptoms & sensory sx. It could be a migraine- but i have never had 1/2 my tongue numb! I think it maybe related to my sinusitis. I’m going to sterilize my Nettie pot & see if I can irrigate some of this purulent discharge. I don’t have a headache.
Thank you.

You are very welcome! My pleasure! I am very glad you found the above information helpful!

Yes, seeing your MD tomorrow is fine too since it does not appear this is an emergency situation. Okay I see if the bell’s palsy you have had included both motor and sensory symptoms then this still could be bell’s palsy which started with just sensory symptoms, so starting antiviral agents such as valacyclovir at the earliest will give the best prognosis and best outcome. Other possibilities include migraine related numbness or even sinusitis too can rarely cause numbness of the face and tongue. But it is good you are seeing your MD tomorrow, a thorough clinical examination can assist in finalizing the diagnosis. And in the meantime neti pot irrigation of the sinuses and nasal cavity can help in getting rid of some of the purulent discharge you have been having. Your MD will also make a decision on modifying antibiotic coverage too since the infection has not been responding to the Zpak course you have already tried.

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Wishing you all the very best!

Best Regards!

Dr Subbanna MD

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Customer reply replied 1 month ago
I just took a Valcyclovir & I’m going to take some B complex. My nutrition has been poor do to my recent illness. My left arm now does feel a little strange - kind of numb & heavy. & now that I’ve gotten up my leg is numb & weak feeling. So maybe i am having a hemiplegic migraine on the left side! It is all related to stress. I’ll check my BP in a few minutes & see what it is up to. It has been mildly elevated 140’s/70’s . Due to my stressful boss! He gave me some Bystolic samples- I haven’t been taking them because I have mostly been in bed rest with the flu etc. I doubt it is a stroke.

Yes, this appears the hemiplegic migraine is occurring on the left side this time

So this is new migraine pattern for you

Migraine is known to change its pattern sometimes like this

And stress appears the triggering factor

Once again, this does not appear stroke, rather this appears hemiplegic migraine that got precipitated from severe stress you have been undergoing

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Customer reply replied 1 month ago
I think u r right about the hemiplegic migraine. I’ll take a shower & a Xanax & Bystolic & I should get better. Better Living through Chemistry! Thank you for your through reply. U R 5 Star !
Customer reply replied 1 month ago
BP 145/86

You are very welcome!

I appreciate the compliments too!

Yes, this appears hemiplegic migraine rather than a real stroke so no need to visit the er etc and you can try the treatments as you have mentioned above.

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,125
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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Dr Subbanna MD
Dr Subbanna MD
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Category: Neurology
Satisfied Customers: 6,125
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Experience: American Board Certified Neurologist, Internal Medicine

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