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facial neuralgia & dysphagia

The presence of multiple neurologic signs (upper & lower facial droop,
dysarthria and dysphagia) suggest your patient may have had a neurologic
insult, despite the fact that CT & MRI are normal.
>From Bassetti C & Bogousslavsky J, Sensory disturbances. In: Stroke
syndromes (Bogousslavsky J & Caplan L, eds), NY : Cambridge 1995:
"... pain can appear with severe hemihypesthesia, but also with little, if
any, clinical sensory loss ... It usually appears after a latency of weeks
or months (rarely, years) and can be felt in the upper or lower limb ...
the face..., the tongue, hand, and foot together ..., or the entire
hemibody... Such pain is severe and is resistant to all kinds of
treatment; it has a diffuse burning or aching quality and can appear
spontaneously or after somatic, visceral, or emotional stimuli ... "Pain
after stroke" is suggestive of, but not specific for, thalamic lesions."
(p 23)
Anecdotally, I know two patients who developed facial pain some weeks
after circumscribed brainstem strokes during the course of thermal
stimulation -- of course, we immediately d/c'd thermal stim in these two
patients and were *alert* to this potential problem thereafter.

On Tue, 22 Jul 1997, Carla Brauer wrote:

> Dear Jane,
> A friend of mine had gone through similar problems due to facial neuralgia.
> She had been to all kind of specialists (TMJ, ENT, Neurologist,
> Psiquiatrist, etc).
> She actually saw a neurologist at Sunnybrook (can't recall his name).
> She also suffered from depression, but I believe that PAIN was the reason
> for feeling depressed.  She also had facial drooping (eyes, lips), she
> complained of poor articulation (? dysarthria, maybe) and difficulties in
> swallowing solids.
> Unfortunatelly, the specialists didn't get to a conclusion.  They all
> suspect of trigemial nerve damage, but she had MRI, CT scan, etc., and
> results did not show any problems.
> She also had seen dentists, but no one was able to find a reasonable
> explanation for the pain and symptoms.  As far as I know, she continues to
> be on pain killers.
> It is very sad.
> P.S. : she also had treatment with reflexologists, alternative medicine,
> with no success.
> Sorry if I cannot help, but I thought you would be interested in hearing a
> similar case.
> P.S. 2: my friend is 40 yrs old.
> E-mail me if you need further info.
> Carla Brauer
> S.T.E.P. Associates

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