Numbness
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
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
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