Case

A woman in her 50s woke with facial numbness, initially involving the right nasal and perioral regions, but progressing gradually over 3 days to involve the whole of the right side of her face to the vertex. She had no associated pain or headache. She described a ‘freezing’ sensation to the right side of her face and constant ipsilateral numbness of her gums and palate but not her tongue. Her ear was unaffected. There were no ocular, bulbar, bladder or bowel symptoms and no peripheral motor or sensory disturbance. She was systemically well. Three days before, she had undergone a non-surgical cosmetic procedure to her abdomen with fat dissolving injections. She had chronic obstructive airway disease and was an ex-smoker. There was no history of venous or arterial thrombosis. She was normotensive and the only neurological finding was complete sensory loss to light touch and pin prick along the distribution of all three sensory divisions of the right trigeminal nerve. There were no cerebellar signs.

She had a mild lymphocytosis but …