I don't know much about this area, but besides the possibility of some
specific/localized nerve damage related to specific site of injection,
another angle too consider is propensity of local anesthetics (cocaine,
procaine, et al.) to provoke seizure activity, and possible
explanations of symptoms in terms of "partial continual epilepsy".
People vary in susceptibility to this effect. I myself feel a bit
"spacy" with lidocaine, I believe.
F. Frank LeFever, Ph.D.
New York Neuropsychology Group
In <915203224.961121 at mnementh.southern.co.nz> Brian Sandle
<bsandle at southern.co.nz> writes:
>>I thought to follow up to the Brain stem thread, but maybe this
article
>has vague relevance here.
>************************
>X-URL:
http://neuro-www.mgh.harvard.edu/forum/TrigeminalNeuralgiaF/NumbSeizure
afterAnesthet.html
>>> Numb & Seizures? after Anesthet
>>> This response submitted by Brian Sandle on 1/1/99.
> Email Address: bsandle at southern.co.nz>> First dental anesthetic 1970s affected face to hair line. Avoided
> injections. Less touch senstive patch under left1ear around mid
1980s.
> Had eighth nerve test O.K. New dentist 1993 insists on injections.
> Told him I feel seizure like for some days. Still insists. Left
side
> of face not so tickle sensitive. Recent injection surprises with
> sudden rush of wrong feeling to left forehead. Even left eye tired
now
> 9 days later after upper 6th molar root dressing. Feel a bit jerky
> trying to right sensation. Anesthesia damage as1when diabetics'
nerves
> hurt? TN? Thalamus? sci.med.dentistry before.
>*********************************
>It is not very uncomfortable, but I don't want it to get worse if
possible.
>*********************************
> Re: RFI: tongue still numb 2mo after anaesthetic more options
>> Author: Brian Sandle
> Email: bsandle at southern.co.nz> Date: 1997/03/25
> Forums: sci.med.dentistry
>>Dr.W.Lee (docle at idirect.com) wrote:
>: In article <5gl87q$f89 at news.istar.ca>, agwyvern at istar.ca says...
>: >
>: >I had a crown lengthening done recently (January) on teeth 36, 37,
38
>: >(Canadian numbering system: lower left, back 3 teeth). My dentist
>: >administered anaesthetic by needle (I don't know the name) to a few
>: >locations. Unfortunately, my understanding is that on one of the
>: >applications the needle met a nerve dead-on: it felt like a wave of
fire
>: >in my mouth.
>: >
>: >At this point, I still have a numb sensation along the left side of
my
>: >tongue from the 38 location right to the tip (the tip only started
going
>: >numb a few days ago).
>: >
>: >Does anybody have any idea what actually could have happened here
and
>: >will the sensation likely disappear?
>: >
>: >Thanks in advance for any info you can supply.
>: >
>: >agwyvern at istar.ca>:>: The needle has likely touched upon the lingual nerve during the
administratio
>n
>: of the anaesthetic. While trying to inject the anaesthetic as close
as
>: possible to the nerve, it's quite possible that the tip of the
needle had com
>e
>: in contact with the nerve. But you shouldn't worry. I've never
heard of a
>: case where there was a permanent nerve damage from a needle
injection in the
>: mouth. I had a patient who had same symtoms as you (after a routine
procedur
>e
>: involving anaesthetic) that lasted about a month then sensations
completely
>: returned. If the problem lasts more than six months, it may be
possible that
>>: the nerve had been damaged by the surgical procedure rather than the
needle.
>:>: Dr.W.Lee DDS
>:>But the fact that the deadness is increasing must be a worry.
>>Can an injection lead to a small stroke in any patient, perhaps blood
>pressure prone or prone to blood clots?
>>How would it be known whether a clot is local to the tongue nerve or
more
>in the brain?
>>I would like to suggest the following research:
>>Do a neurological map of tickle, pressure and warmth senstivity of
>several areas of the patients' heads and mouths several times before
and
>after anaesthesia.
>>Should the patient be checked for thrombosis?
>>Brian Sandle
>****************************
>> Anesthesiology 1992 Nov;77(5):941-7
>>Local anesthetic-induced conduction block and nerve fiber injury in
>streptozotocin-diabetic rats.
>> Kalichman MW, Calcutt NA
>> Department of Anesthesia, Veterans Administration Medical Center,
San
> Diego, California 92161-9151.
>> Patients with diabetes may have peripheral neuropathy, which may
have
> clinical implications for the use of regional nerve block. The
effects
> of local anesthetics on nerve conduction and nerve fiber injury
were
> tested in control rats and at 4 weeks after the onset of diabetes
in
> rats injected with streptozotocin (50 mg/kg intraperitoneally).
Nerve
> conduction was assessed by recording evoked electrical activity in
> hindpaw muscles following ipsilateral electrical stimulation of the
> sciatic nerve near the hip. Block of motor nerve conduction was
> quantified by recording the amplitude of the evoked response at
1-min
> intervals for up to 15 min after the injection of 500 microliters
1%
> lidocaine HCl or procaine HCl into the midthigh next to the sciatic
> nerve. In control animals, procaine was much less effective than
> lidocaine in producing conduction block. The rate and magnitude of
> lidocaine-induced conduction block were not significantly different
> between control and diabetic groups. However, conduction block due
to
> procaine was sufficiently enhanced in diabetic rats to become
> comparable to that of lidocaine-treated control nerves.
Long-lasting
> injury was assessed in sciatic nerve harvested 2 days after the
> extraneural injection of saline or 2 or 4% lidocaine HCl. Using a
> light microscope with a superimposed grid, nerve edema was
quantified
> as the proportion of intersection points falling on extracellular
> space. Lidocaine induced edema in both control and diabetic nerves,
> but 4% lidocaine induced significantly more edema in diabetic
nerves
> than in controls. Nerve fiber injury, based on light microscopic
> scoring of axonal degeneration and demyelination, was not observed
in
> saline-treated nerves.
>> Comments:
> * Comment in: Anesthesiology 1993 Apr;78(4):799-800
>> PMID: 1443749, UI: 93073081
>**************************
>>Krakatoa <stephan at nospam.ucla.edu> wrote:
>: In article <76e2gm$a00$1 at nnrp1.dejanews.com>, tamuller91 at hotmail.comwrote:
>>:> I saw a neurologist about some numbness in the tip of my nose and
upper lip
>:> after being rear-ended in a car accident about a month ago. He
seemed
>:> unconcerned and was satisfied with waiting another month to see if
it got
>:> better or worse (it hasn't changed since the accident), but I'm
not!! He
>:> seemed to doubt whether or not it was a results of the accident
(no, I didn't
>:> hit my face on anything, I just got a good slam into the headrest
at a torqued
>:> angle. My car was totalled). I was slowing to a stop, leaning
forward and
>:> looking right when I was hit from behind. I think I should insist
on an MRI.
>:> Anyone else have any other suggestions? And... what exactly does
an MRI do to
>:> you, anyway?
>:>>:> Thanks for your help. (I'm very scared about this!).
>:>>:> T.A. Muller
>:>>:> -----------== Posted via Deja News, The Discussion Network
==----------
>:>http://www.dejanews.com/ Search, Read, Discuss, or Start Your
Own
>>: It is extremely unlikely an MRI would reveal anything. It is also
unlikely
>: any insurance company will cover the $3000+ cost either, unless they
are
>: in the Christmas spirit.
>>: If the symptoms are caused by neurological damage it is probably
quite
>: mild, which is the main reason an MRI would be useless (of course,
knowing
>: there is damage there would also be useless anyway, since there is
nothing
>: you could do about it). MRIs are useful if you need to identify and
>: localize substantial damage. Even then, this information is only
useful
>: if you plan on doing something about it (like surgery for a tumor or
>: hematoma); in your case, any surgery would likely make it worse,
since the
>: symptoms are mild. Most likely, if the cause is neurological, it's
>: caused by minor nerve damage or inflammation which will often
dissapear as
>: peripheral nerves are repaired or inflammation goes away.
>>: So my 2c worth would to wait and hope it goes away. If you are not
>: experiencing pain, this is the most important thing, and virtually
>: anything you do about it may lead to pain, which is much worse than
a loss
>: of sensation...
>>: Good luck and don't be afraid! if you lasted a month you will be
fine.
>>: Stephan
>