I am a thirty-five-year-old female who follows an active and healthy lifestyle. However, over the past year and a half, I have been experiencing some symptoms on the right side of my face that concern me: eye discomfort (sensation of pressure and a feeling that something is in my eye), particularly upon waking; eye twitching; difficulty duplicating movements that appear strong on the left side (e.g., raising eyebrow, frowning). I have no family history of neurological disease, and my doctor tells me everything is fine. But other people are beginning to notice. The doc ordered an MRI, which showed a small abnormality, but he said that many people have such abnormalities and are not adversely affected by them, that they are not necessarily a sign of a health problem.
I am trying to convince myself that he is right, but my face says otherwise. What are your thoughts on the matter?

Doctor Joshua’s Answer:

Working from your description alone, to me it seems that you show some signs of right facial nerve (7th cranial nerve) palsy. You have some atypical (uncommon) symptoms as well, but generally this sounds like slowly progressing peripheral 7th nerve palsy.

The fact that it has been progressing slowly speaks against the so-called Bell’s palsy, in which the palsy often develops over a short period of time, like a couple of days. With Bell’s palsy, the cause is often undetermined, but recovery is usually good.

The fact that your eye and eyebrow region is affected fortunately suggests that the palsy is not caused by a lesion in the brain matter, namely in the motor areas. Rather it suggests that something is irritating the facial nerve itself, either in the inner ear structures, or near the origin of the nerve, or the region where it exits the skull.

What exactly was the finding on the MRI? Can you send me a copy of the report?

The best thing to do would be to make an appointment with a neurologist first, then maybe an ENT (ear, nose and throat) specialist if the neurologist finds nothing wrong. I’d like to see your symptoms properly evaluated. There are many possible causes for this, and as many treatments, and I cannot evaluate the problem over the internet. However, I hope I managed to point you in the right direction - and I hope you keep me posted!