Altered Sensation

Question 1

Sequence of events

Answer 1

Open question
Timeline- how did it start, progression since then

Question 2

Symptom analysis

Answer 2

SOCRATES

Site- where do you get the feeling, is it both sides of body
Onset- when did you first notice it, suddenly or gradually
Character- describe what it feels like exactly
Radiation- same sensation anywhere else
Associated features- see systems review
Timing- there all the time or come and go
Exacerbating or relieving factors- worse with stress, heat, or exercise
Severity- affecting you day to day

Question 3

Systems review

Answer 3

NS- vision, hearing, taste, smell, eye pain, blurred vision, muscle weakness, balance, speech difficulties, headaches, seizures and blackouts

Pain, incontinence, anxiety (do you feel anxious before it happens)

Vascular- does it happen when hands or feet are cold, do they turn white the blue then red, painful when red etc.

Constitutional- FWARJNLCT

Question 4

Patients perspective

Answer 4

Feelings and effect on life
ICE

Question 5

Background information

Answer 5

PMH
DH
FH
SH- alcohol can be a cause of neuropathy

Question 6

MS

Answer 6

Common presentations- optic neuritis, altered sensation, weakness and ataxia
INSULAR- intention tremor, nystagmus, slurred speech, urogenital Sx, labile emotions, ataxia, retrobulbar neuritis
Have to ask about previous episodes to make a diagnosis however

Question 7

Stroke/TIA

Answer 7

Sudden onset
Other neurological symptoms likely eg. Motor, speech, eyesight

Question 8

SOL (tumour or abscess)

Answer 8

Slowly evolving symptoms such as seizures, focal neurological deficits, cognitive/personality changes, signs of raised ICP

Question 9

Radiculopathy

Answer 9

Pressure on nerve root affecting sensory or motor modalities of that root

Question 10

Cervical spondylosis

Answer 10

Alternated sensation below level affected (neck stiffness possible)
Upper limb- LMN sign
Lower limb- UMN sign

Question 11

Spinal stenosis

Answer 11

Pressure on spine from mass, trauma
Sensory level with altered sensation below affected level
LMN signs at affected level, UMN signs below affected level
Neuropathic claudication

Question 12

Syringomelia

Answer 12

Specific area of sensory or motor loss related to location of syrinx
Usually one sensory tract is lost at a time eg. Spinothalamic
Symptoms may worsen due to events such as trauma, sneezing or coughing

Question 13

Mononeuropathy

Answer 13

Affects a single dermatome and or myotome, can be motor sensory or both
Can happen following trauma/nerve compression eg common peroneal nerve palsy

Question 14

Mononeuritis multiplex

Answer 14

Inflammation of multiple single peripheral nerves causing pain, numbness, weakness, associated with DM, autoimmune infections, or amyloidosis

Question 15

Polyneuropathy

Answer 15

Causes ABCDE- alcohol, vitamin B deficiency, chronic renal failure, diabetes and everything else (MS, cancer, amyloidosis)
Mainly motor or sensory (glove and stocking), or mixed

Question 16

Anxiety attacks (+-hyperventilation)

Answer 16

History of anxiety with tingling sensations around mouth and in fingers
Sympathetic response- tachycardia, sweating, trembling, shaking

Question 17

Raynauds phonomenom

Answer 17

Hands turn from white to blue to red with severe pain, often when cold
Primary Raynauds very common and benign
Secondary causes include scleroderma, lupus, vasuciltis- get distal necrosis and ulcers

Question 18

Investigations

Answer 18

Neurological examination, finger prick BM
Bloods-FBC UE HBA1c blood glucose (may be new diabetes diagnosis) vitamin B12 and folate
Nerve conduction studies
MRI. head/spinal cord (depends on findings)