Facial Numbness & Stroke: Silent Infarcts & Causes

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BOSTON, November 15, 2023 – A seemingly isolated instance of facial numbness could be an early warning sign of a stroke, even when initial brain scans appear normal, a recent case report reveals. Doctors discovered multiple areas of brain damage in a patient who initially presented with only numbness on one side of their face.

The Subtle Signals of Silent Strokes

A seemingly minor symptom like facial numbness can sometimes precede a more serious neurological event.

• Facial numbness, even without other stroke symptoms, warrants immediate medical evaluation.
• Standard imaging may initially miss small, developing strokes.
• Multiple strokes, or multifocal infarcts, can occur concurrently or sequentially.
• Identifying underlying causes, like atrial fibrillation, is crucial for prevention.

What does facial numbness have to do with stroke? A 61-year-old man presented to the emergency department with a complaint of numbness on the left side of his face. Initial neurological exams were largely unremarkable, and a standard computed tomography (CT) scan of the brain showed no acute abnormalities. However, the numbness persisted, prompting further examination with magnetic resonance imaging (MRI).

Beyond the Initial Scan

The MRI revealed multiple areas of brain damage – known as multifocal infarcts – in both the right and left hemispheres. These areas weren’t immediatly apparent on the initial CT scan. Further testing uncovered the patient had paroxysmal atrial fibrillation, an irregular heartbeat that can lead to blood clots and stroke.

The case underscores the importance of considering stroke even when symptoms are atypical and initial imaging is negative. A high index of suspicion and repeat imaging may be necessary to identify subtle strokes.

Doctors initiated anticoagulation therapy to prevent further clot formation. The patient’s case highlights the potential for “silent strokes” – strokes that cause minimal or no noticeable symptoms – to accumulate over time and lead to significant neurological deficits.

understanding the risks

Here’s a closer look at some key terms related to this case:

• What is a multifocal infarct?
  A multifocal infarct refers to the presence of multiple areas of brain damage caused by stroke.
• How is atrial fibrillation related to stroke?
  Atrial fibrillation can cause blood clots to form in the heart, which can then travel to the brain and cause a stroke.
• What is small vessel disease?
  Small vessel disease is a condition where the small blood vessels in the brain become blocked, leading to brain damage.