Numbness / Paraesthesia Flashcards
What are some causes of numbness and paraesthesia?
Divide into Central, Spinal and Peripheral and non-neurological
Central
- MS
- Stroke / TIA
- Tumor / Abscess
Spinal
- Radiculopathy
- Spinal stenosis
- Cervical spondylosis
- Syringomyelia
Peripheral
- Mononeuritis multiplex
- Mononeuropathy
- Polyneuropathy
Non-neurological
- Anxiety attacks (+/- hyperventilation)
- Raynaud’s phenomenon
What are the symptoms of MS?
INSULAR
I - Intention tremor
N - Nystagmus
S - Slurred speech
U - Urogenital symptoms (incontinence and ED)
L - Labile emotions and Lhermitte’s sign
A - Ataxia
R - Retrobulbar neuritis (pain on eye movement)
How may numbness and paraesthesia due to a central tumor/abscess present?
Slowly evolving symptoms such as SEIZURES
Change in behaviour / personality / cognition
Focal neurological deficits
Signs of raised ICP such as HEADACHES
How may numbness and paraesthesia caused by stroke / TIA present?
Sudden onset
Any part of the CNS
Other neurological symptoms likely such as motor, speech and eye problems
What are some radiculopathies that may cause numbness and tingling?
Pressure on nerve roots affecting sensory or motor modalities from that root.
Singles can cause intense pain and blistering in dermatomal distribution
Meralgia paraesthetica - thigh numbness due to irritation of lateral cutaneous nerve of thigh
What are the features of cervical spondylosis?
Altered sensation below level affected
Neck stiffness possible
Upper limbs - LMN signs
Lower limbs - UMN signs
leading cause of progressive spastic quadriparesis with sensory loss below the neck
Pain in arms or fingers at the level of compression with dull reflexes and dermatomal sensory disturbance, LMN weakness and eventually wasting of muscles innervated by affected root.
Below level of affected root (examine the leg) there may be UMN signs suggestive of a cord compression: spasticity, weakness, brisk reflexes, up going plantar, position and vibration may also be lost. Examine for a sensory level.
What are the features of spinal stenosis?
Pressure on spine from mass, trauma or spondylolisthesis
Sensory level with altered sensation below affected level.
LMN signs at affected level. UMN signs below affected level.
What are the features of syringomyelia?
Specific areas of sensory and motor loss related to location of syrinx
Usually one sensory tract lost at a time, e.g. spinothalamic tract
Sx may worsen due to events such as trauma, sneezing or coughing
What are some common mononeuropathies and what are the features?
Mononeuropathies can be due to trauma, infection or carpal tunnel syndrome
Affects single dermatome and/or myotome; can be motor, sensory or both
What are the features of mononeuritis multiplex?
What are some common causes? (WARDS PLC)
WARDS PLC
Wegners AIDs / Amyloid Rheumatoid Diabetes Sarcoidosis
PAN
Leprosy
Carcinomatosis
Inflammation of multiple single peripheral nerves causing pain, numbness, and weakness associated with above conditions.
What are some causes of polyneuropathy and what are the features of it? (ABCDE)
Alcohol B vitamin deficiency Chronic renal failure Diabetes Everything else (MS, cancer, amyloidosis)
Can be mainly motor or sensory (glove & stocking) or mixed. Weakness is often distal.
How may numbness and tingling present in anxiety attacks?
Tingling sensations around the mouth and in fingers
Sympathetic response also
- Sweating
- Tachy
- Trembling or shaking
What are the features of Raynaud’s phenomenon?
Hands turn from white to blue to red (with severe pain), often when cold.
Primary Raynaud’s is benign and common.
Secondary causes include autoimmune conditions such as lupus.
How may you manage carpal tunnel syndrome?
Splinting
Local steroid injection
Carpal tunnel release surgery if problematic
