Numbness

Clinical Features

Localizing the problem by history & physical

• 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
• Associated with autonomic features
  • Alcohol use disorder
  • Amyloidosis
  • Chemotherapy-related neuropathy
  • 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

See Also

• Focal neurologic deficits