HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Causes Pain On The Left Side Of Face?

Posted on Mon, 10 Aug 2015

Question: Dear doctor my sister in law aged 43 years having pain on left side of face since 8 months , it's fluctuating , on and off and remains for several hours , we have consulted many physician,right now she on analgesic medication but pain does not relieve and medication having sedative , and MRI done kindly advised for what should we do exactly

Answered by Dr. Neeraj Kumar (1 hour later)

Brief Answer:
Detailed information require , May be trigeminal neuralgia

Detailed Answer:
Hello Dear,
I have gone through your question and understand your concerns.
Your sister in law may be suffering from most probably trigeminal neuralgia.
What is the character of pain .Is it lightining. Any associated loss of sensation over face. Any hearing loss, facial deviation, headache , vomiting, diplopia, dysphagia, speech abnormalities, nasal regurgitation.
Any toothache or sinus problems.
Is MRI normal. Was MR angiography and FIESTA sequences done on MRI.

For treatment carbamazepine, pregabalin, gabapentin, amitriptyline can be used.
Please reply with above mentioned answers.
Hope you found the answer helpful.
Do get back to me for further queries and clarification.
Regards
Dr Neeraj Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Neeraj Kumar (11 minutes later)

Character of pain is dull and pain at lower jaw , no other symptoms as mention in your question

Answered by Dr. Neeraj Kumar (19 minutes later)

Brief Answer:
Consult a dentist and then neurologist

Detailed Answer:
Hello dear,
Continuous lower jaw pain should be first evaluated for any dental cause and if all is normal then neuropathy involving cranial trigeminal nerve should be suspected.
Proper clinical examination may help in arriving at diagnosis.
What is the Mri report.
Please communicate as soon as possible.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Neeraj Kumar (21 minutes later)

Dear sir MRI report is uploaded kindly go through the attachment , dentist has been consulted he have given opinion pain not related to dental problem , MRI report says vascular loop abutting the left trigeminal nerve in its prepontine segment , she has already taken the carbamazepine medication but no relief , we are very worried want know is this curable

Answered by Dr. Neeraj Kumar (24 minutes later)

Brief Answer:
Treatment is possible

Detailed Answer:
Hello Dear,
The MRI report is also supporting the diagnosis of Trigeminal neuralgia caused by compression of nerve at the exit point near brainstem. This occurs most commonly by vascular loops.
The symptoms may be controlled by drugs. Carbamazepine at 200-300 mg tds, pregabalin 75-150 mg hs, amitriptyline 10-25 mg hs can be taken . The drugs have sedation as side effect and should be gradually added and increased in dose.
Surgical options are there when medications are not helpful. Alcohol ablation of nerve roots can also be tried.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Neeraj Kumar (8 hours later)

Thank you for your kind advised , one more question can vascular loop around nerve root arises sunddenly , I mean so late at this age of life

Answered by Dr. Neeraj Kumar (10 hours later)

Brief Answer:
No the vascular loop does not arise suddenly

Detailed Answer:
Hello dear,
No the loop does not arise suddenly but due to age related atherosclerosis, blood pressure changes and brain atrophy the relationship of vessels and nerves may change with time.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj