Numbness: Difference between revisions
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==Background== | ==Background== | ||
[[File:23-Sensory-Homonculus.png|thumb|Sensory Homonculus - courtesy AnatomyZone.com]] | |||
[[File:Dermatomes and cutaneous nerves - anterior.png|thumb|Dermatomes and cutaneous nerves - anterior]] | |||
[[File:Dermatomes and cutaneous nerves - posterior.png|thumb|Dermatomes and cutaneous nerves - posterior]] | |||
[[File:Cutaneous innervation of the upper limb.svg|thumb|Cutaneous innervation of the upper limb]] | |||
[[File:Lower limb peripheral innervation.png|thumb|Lower limb peripheral innervation]] | |||
==Clinical Features== | ==Clinical Features== | ||
Rosenfeld J, Martin RA, Bauer DW. "Chapter Three - Numbness: A Practical Guide for Family Physicians." American Academy of Neurology. https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/4.CME_and_Training/2.Training/4.Clerkship_and_Course_Director_Resources/FM_Chp3.pdf</ref>=== | ===Localizing the problem by history & physical<ref>Rosenfeld J, Martin RA, Bauer DW. "Chapter Three - Numbness: A Practical Guide for Family Physicians." American Academy of Neurology. https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/4.CME_and_Training/2.Training/4.Clerkship_and_Course_Director_Resources/FM_Chp3.pdf</ref>=== | ||
*Distribution of symptoms | *Distribution of symptoms | ||
**Right vs. left | **Right vs. left | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peripheral neuropathy DDX}} | |||
==Evaluation== | ==Evaluation== | ||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0;"|'''''' | | align="center" style="background:#f0f0f0;"|'''Region''' | ||
| align="center" style="background:#f0f0f0;"|'''Distribution''' | | align="center" style="background:#f0f0f0;"|'''Distribution''' | ||
| align="center" style="background:#f0f0f0;"|'''Facial Involvement''' | | align="center" style="background:#f0f0f0;"|'''Facial Involvement''' | ||
| align="center" style="background:#f0f0f0;"|'''Pain''' | | align="center" style="background:#f0f0f0;"|'''Pain''' | ||
|- | |- | ||
| Brain||Unilateral||Often|| | | '''Brain'''||Unilateral||Often||No | ||
|- | |- | ||
| Spinal cord||Bilateral||No||Possible | | '''Spinal cord'''||Bilateral||No||Possible | ||
|- | |- | ||
| Nerve root||Unilateral||No||Yes | | '''Nerve root'''||Unilateral||No||Yes | ||
|- | |- | ||
| Nerve||Unilateral or bilateral||Possible||Yes | | '''Nerve'''||Unilateral or bilateral||Possible||Yes | ||
|} | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Cause''' | |||
| align="center" style="background:#f0f0f0;"|'''Acute (Days)''' | |||
| align="center" style="background:#f0f0f0;"|'''Chronic (Weeks-Months)''' | |||
|- | |||
| Immune||Guillain-Barre & variants, vasculitis||Chronic demylinating neuropathy | |||
|- | |||
| Toxins||Botulism, buckthorn, diphtheria, tick, arsenic, organophosphates, thallium, vacor||Heavy metals, environmental chemicals | |||
|- | |||
| Drugs||Captopril, gangliosides, gold, nitrofurantoin, suramin, zimeldine||chemotheraputic agents | |||
|- | |||
| Metabolic||Porphyria||Porphyria, diabetes | |||
|- | |||
| Nutritional||||Vitamin toxicity or deficiency | |||
|- | |||
| Hereditary||||Hereditary motor and sensory neuropothy, hereditary sensory neuropathy | |||
|} | |} | ||
==Management== | ==Management== | ||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Symptoms]] | |||
Latest revision as of 19:42, 22 October 2025
Background
Clinical Features
Localizing the problem by history & physical[1]
- Distribution of symptoms
- Right vs. left
- Presence of facial involvement
- Arm vs. leg
- Proximal vs. distal
- Symmetric vs. asymmetric
- Characteristics of symptoms
- Sensory and motor
- Painless or Painful
- Sensory only
- Autonomic involvement
- Temporal Features
- Acute or Chronic
- Static or Progressive
Differential Diagnosis
Peripheral neuropathy
- Peripheral nerve syndromes (mononeuropathy)^
- Acute trauma
- Chronic nerve entrapment
- Mononeuritis multiplex^^
- Acute
- Diabetes mellitus
- Polyarteritis nodosum
- Connective tissue diseases (e.g., SLE, rheumatoid arthritis)
- Chronic
- Multiple compressive neuropathies
- AIDS
- Sarcoidosis
- Acromegaly
- Leprosy
- Lyme disease
- Idiopathic
- Acute
- Associated with autonomic features
- Alcohol use disorder
- Amyloidosis
- Chemotherapy-related neuropathy
- Chronic nitrous oxide abuse
- Diabetes mellitus
- Heavy metal toxicity
- Porphyria
- Primary dysautonomia
- Vitamin B12 deficiency
- Associated with pain
- Alcohol use disorder
- Amyloidosis
- Chemotherapy (heavy metal toxicity)
- Diabetes mellitus
- Idiopathic polyneuropathy
- Porphyria
- Paraneoplastic syndrome
- Vitamin B1 or B12 deficiency
- Arsenic toxicity
- Thallium toxicity
^A condition in which a single nerve is damaged or compressed.
^^A condition where damage to at least two separate peripheral nerves results in a painful, asymmetric, and asynchronous presentation of sensory and motor deficits.
Evaluation
| Region | Distribution | Facial Involvement | Pain |
| Brain | Unilateral | Often | No |
| Spinal cord | Bilateral | No | Possible |
| Nerve root | Unilateral | No | Yes |
| Nerve | Unilateral or bilateral | Possible | Yes |
| Cause | Acute (Days) | Chronic (Weeks-Months) |
| Immune | Guillain-Barre & variants, vasculitis | Chronic demylinating neuropathy |
| Toxins | Botulism, buckthorn, diphtheria, tick, arsenic, organophosphates, thallium, vacor | Heavy metals, environmental chemicals |
| Drugs | Captopril, gangliosides, gold, nitrofurantoin, suramin, zimeldine | chemotheraputic agents |
| Metabolic | Porphyria | Porphyria, diabetes |
| Nutritional | Vitamin toxicity or deficiency | |
| Hereditary | Hereditary motor and sensory neuropothy, hereditary sensory neuropathy |
Management
Disposition
See Also
External Links
References
- ↑ Rosenfeld J, Martin RA, Bauer DW. "Chapter Three - Numbness: A Practical Guide for Family Physicians." American Academy of Neurology. https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/4.CME_and_Training/2.Training/4.Clerkship_and_Course_Director_Resources/FM_Chp3.pdf