Unilateral Neurological Symptoms Following Neck Positioning

Case at a Glance

A 36-year-old Hispanic female presents with persistent left-sided facial numbness, arm and leg tingling following prolonged neck positioning against a couch armrest 14 hours prior.

Patient's Story

The patient reports that while resting on her couch, she inadvertently positioned the left side of her neck directly against a tufted armrest for approximately 20 minutes. Upon changing position, she immediately noticed mild numbness on the left side of her face accompanied by tingling sensations extending down her left arm and leg. Despite remaining upright for an hour to promote circulation, the symptoms persisted. At presentation, 14 hours post-incident and after 5 hours of sleep, she continues to experience uncomfortable tingling in her left arm and leg, with ongoing facial numbness. She reports mild lightheadedness but attributes this to sleep deprivation. Notably, she denies any neck pain.

Initial Assessment

Patient is a 36-year-old female with known hypothyroidism on levothyroxine 25 mcg daily. She maintains a healthy lifestyle with no history of smoking, alcohol consumption, or recreational drug use. Physical examination reveals unilateral neurological symptoms affecting the entire left side of her body, including facial numbness and extremity paresthesias, without associated cervical pain.

The Diagnostic Journey

The temporal relationship between neck positioning and symptom onset initially suggested a mechanical etiology. However, the distribution of symptoms affecting the entire left hemibody raised concerns for central nervous system involvement rather than isolated peripheral nerve compression. The persistence of symptoms beyond the expected timeframe for simple positional nerve compression warranted further investigation.

Final Diagnosis

Pending comprehensive neurological evaluation to differentiate between peripheral nerve compression, cervical spine pathology, or potential central nervous system etiology including cerebrovascular events.

Treatment Plan

Immediate referral to emergency department for comprehensive neurological examination, including detailed cranial nerve assessment, motor and sensory testing, and appropriate neuroimaging studies. Given the unilateral distribution and persistence of symptoms, urgent evaluation was recommended to rule out serious underlying pathology.

Outcome and Follow-up

Patient advised that while peripheral nerve compression could explain localized symptoms, the hemibody distribution of numbness and tingling warranted immediate medical evaluation to exclude more serious etiologies and ensure appropriate diagnostic workup and management.