Sensory Disturbance Interview Flashcards
What is sensation?
Stimuli detected by specialised receptors in skin/muscles/joints
Transmitted to brain via PNS
What does sensation allow the body to do?
Maintain posture
React to pain and other noxious stimuli
Provide info about surrounding envrio
Is sensation a continuous process?
Yes
Is sensation a conscious process?
Usually no
What can disordered sensation cause?
Considerable disability and distress
What are the three parts to gathering information about sensory disturbance?
What symptoms
Pattern
Underlying cause
What are the two main categories of sensory symptoms?
Positive
Negative
What are positive sensory symptoms caused by?
Heightened activity in sensory pathways
What are negative sensory symptoms caused by?
Loss of sensory function
What sort of descriptions will patients use when describing positive sensory symptoms?
Tingling Pins and needles Pricking Burning Tightness Band-like sensation around body Electric shock Pain - often sharp and stabbing
Do patients with positive sensory symptoms have sensory deficits on examination?
Usually no
Define paraesthesia
Abnormal sensation perceived without abnormal stimulus
Define hyperaesthesia
Abnormal increase in sensitivity to stimulus
Define dysaesthesia
All positive sensory changes whether due to stimulus or not
Define hyperalgesia
Heightened response to noxious stimulus
Define allodynia
Normal stimulus felt as pain
What sorts of descriptions will patients use when describing negative sensory symptoms?
Numbness
Coldness
Loss of feeling in particular distribution
Do patients reporting negative sensory symptoms have sensory deficits on examination?
Often, yes
Define hypoaesthesia
Diminished ability to perceive pain/temperature/touch
Define anaesthesia
Complete inability to perceive pain/temperature/touch
Define analgesia
Complete insensitivity to pain
What might a patient have if they have a sensory disturbance involving the receptors in the muscles, tendons and joints?
Proprioception affected Sensory ataxia - Imbalance - Unsteady gait - Lack of precision with movements
Why is it important to establish the pattern of sensory loss?
Helpful in determining likely site of underlying problem
What are the patterns of sensory loss?
One side of the body
Whole limb or part of limb
Symmetric/asymmetric
What are some common patterns of sensory loss?
Glove and stocking distribution due to peripheral neuropathy
Dermatomal pattern due to spinal cord/nerve root lesion
Area supplied by particular nerve
Hemisensory loss due to lesion of spinal cord/brainstem/thalamus/cortex
What are some examples of CNS conditions that cause sensory disturbance?
Cerebrovascular disease
MS
Tumours
What are some examples of PNS conditions that cause sensory disturbance?
Diabetes
Alcohol excess
Nerve entrapment syndromes
What do you ask about the site?
Where is the sensory disturbance? Does it affect one half of the body? A whole limb? Part of a limb? Is it symmetric or asymmetric?
What do you ask about the quality?
Positive or negative sensory symptoms
Combination of both
What do you ask about the severity?
Determine degree to which sensory symptoms disrupt patient’s life
What do you ask about the time course?
Did it come on suddenly or over days to months?
Is it worse at night?
What do you ask about context?
Is there anything in particular they noticed at the time the sensory disturbance started?
What do you ask about aggravating factors?
Is there anything that makes it worse?
What do you ask about relieving factors?
Is there anything that makes it better?
What do you ask about associated features?
Alcohol use Medications Past history Muscle weakness Gait disturbance Have you sustained any injuries as a result?
What are the three steps to respond to a patient who is emotional?
Identify
Acknowledge
Empathise
