The Clinical Problem Solvers

Episode 339: Neurology VMR – left facial numbness for 5 days

Jun 8, 2024

Dr. Aaron Berkowitz, a neurologist, joins the discussion on left facial numbness in a young woman. The hosts explore the differential diagnosis of conditions like multiple sclerosis and trigeminal neuropathy. They discuss the importance of understanding subjective descriptions, conducting a thorough neurological examination, and differentiating between central and peripheral nystagmus patterns. The podcast also covers the use of MRI imaging in identifying lesions and tumors like vestibular schwannoma, as well as treatment options for benign tumors causing facial numbness.

44:10

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Episode guests

Aaron Berkowitz

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Episode notes

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Quick takeaways

Consider subacute onset for non-vascular causes like Bell's Palsy.

Localized mass causing cranial nerve symptoms requires surgical intervention.

Collaborative neurology-neurosurgery approach crucial in managing cerebellopontine angle tumors.

Deep dives

Summary of the Patient's Presentation

A 32-year-old female presents with left facial numbness for five days. During the discussion, subacute onset is noted, ruling out an immediate vascular cause. Differential diagnoses include Bell's Palsy triggered by an infection, migraines, and episodes of multiple sclerosis. Consideration is given to trigeminal neuralgia and peripheral neuropathy. Detailed examination reveals lower motor neuron facial palsy, reduced sensation, and left hearing loss.

Intro

2min

Case Study: Left Facial Numbness Differential Diagnosis

26min

Neurological Examination Findings and Cranial Nerve Functions Discussion

2min

Discussion on Cranial Nerves, Nystagmus, and Bruns Nystagmus

5min

Discussion on MRI imaging for left facial numbness

4min

Treatment options for a benign tumor causing facial numbness and a case presentation of a cerebral pontine angle tumor

4min

Episode 339: Neurology VMR – left facial numbness for 5 days

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz. This time, Aye presents a case of left facial numbness for 5 days to Andrea and Sridhara.

Neurology DDx Schema

Aye Chan Moe Thant

Aye graduated from University of Medicine, Mandalay, Myanmar, and has been working with her mentor neurologist, one of only three neurologists covering the Upper Myanmar region of 23 million population. Through her experiences witnessing the challenges faced by patients in underserved areas and hearing their stories, Aye is dedicated to advancing health equity, global health initiatives, and various aspects of neurology, both in clinical practice and medical education. She is going to apply for a neurology residency program this year. Outside of work, she spends time playing piano, jogging along trails, and listening to music.

Andrea Mendez Colmenares

@andreamendez92

Andrea Mendez Colmenares is a Venezuelan medical doctor and cognitive neuroscientist. She recently completed her PhD and postdoctoral fellowship in Colorado and will begin her neurology residency at Duke University in North Carolina in the summer of 2024. Outside of medicine, she enjoys playing guitar, discovering new coffee shops, hiking, and climbing mountains.

Sridhara Yaddanapudi

@syaddana_neuro

Sridhara is a board-certified internist, neurologist, vascular neurologist, and hypertension specialist. Currently, he holds the position of Clinical Assistant Professor at Thomas Jefferson University Hospital and serves as the Director of Neurology for Jefferson New Jersey. As a medical professional, he is passionate about case-based learning, clinical reasoning, and teaching decision-making while avoiding the pitfalls of heuristics. His goal is to bridge the ever-growing gap between neurology and internal medicine, an area in which he has a keen interest.

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