This was Tuesday: An hour into my morning clinic, my right lower lip and jaw started to feel like Novocain at the dentist. I found myself discreetly dabbing at saliva dribble as I spoke to patients.
When I had a chance, I peeked in the mirror. You know how when you’re Novocained it feels like your lip is huge and saggy? My face was fine, no sagging.
I remembered having similar symptoms about six months ago, also during clinic. That time, it lasted an hour and a half and then cleared up. I had figured it was some weird migraine thing, though I had no associated headache. I do suffer the occasional migraine, and I have had visual auras in the past. Therefore, that’s what I decided it was.
This time, the numbness spread to my right arm and hand, and I got clumsy with typing. That was new and sort of concerning.
But, patients. I acknowledged my symptoms only to occasionally dab at the corner of my mouth, or delete and re-type orders. I had a full clinic schedule and intended to see everyone. I was still standing, after all.
When there was a moment to consider that these bizarre neurologic symptoms had been going on for a couple hours, I found my favorite curbside colleague and asked her opinion. “Will you please call your doctor?” she appropriately admonished. She pointed out that migraine auras typically do not last this long and don’t act this way.
After my clinic, I called my PCP’s office and made a same-day appointment for late afternoon, of course allowing time to clear out messages, check labs and write prescriptions. The symptoms, meantime, began abating: face first, then arm, then hand. The entire episode lasted five hours. No headache.
By the time I saw my PCP, there was only the mildest of numbness in my right hand, and when she performed her extremely and impressively thorough neurologic exam, I had subtle weakness, on the “pinching paper as it’s pulled away” test.
She was frank. Maybe this was a variant of a migraine aura. But we needed to consider TIA (transient ischemic attack, AKA mini-stroke) and multiple sclerosis. “I want you to have this MRI and angiogram within the next 24 hours, okay?” And she called radiology herself.
I sat quietly, listening to her negotiate for a same-day slot, marveling at what a wonderful doctor she was (with far superior neurologic exam skills). If this was a TIA, I thought, I am a stupid idiot for pushing through clinic.
Getting the imaging done involved a harrowing taxi ride to the wrong address at a satellite location, and then a confused search on foot for the elusive facility, all in oppressive heat.
But the radiology staff was fantastic, directing and guiding me through the process expertly (including dispatching a kind and nonjudgmental tech to fetch me from the parking lot on the wrong side of the building).
As it turns out, my brain is totally normal:
But still, WTF?
My PCP and I hashed this out. Another odd thing is that I’ve just started having really annoying Raynaud’s phenomenon, where any exposure to cold results in numbness and blanching of my fingers. It’s pretty impressive color changes, and can involve one or more fingers:
It’s odd because Raynaud’s doesn’t usually appear at age 45, so when it does, that prompts a workup for other stuff. Which we did. And was negative.
We came to the tentative conclusion that the weird neurologic symptoms are an atypical migraine aura without the migraine, and that the Raynaud’s is just Raynaud’s.
Meantime, we may obtain an echocardiogram to rule out a PFO (patent foramen ovale), which can be associated with TIAs and strokes; and we may ask for a neurology consult.
Any physicians with opinions out there, I welcome your input.