Paraesthesia

Symmetrical

Asymmetrical

Distal

Proximal

DM

  • mx: gabapentin 300mg TDS/TCA
  • refer NEM if very pain/cannot walk

Vit B12 deficiency
- sensory, vibration/proprioception loss

GBS

Drugs

CMT

spinal cord

transverse myelitis

syringomyelia
- cape-like distribution
- motor, pain, temperature

disc prolapse

spondylosis/ fracture/ multiple myeloma/ bone mets

patchy

non-patchy

one patch

multiple patches

Mononeuropathy/ nerve entrapment
- motor signs

plexus

radiculopathy

mononeuritis multiplex
DM, polyarthritis nodosa (autoimmune), sarcoidosis, amyloidosis

  • asymmetrical random patches
  • paraesthesia and weakness

sensory neuropathy
drugs - platinum, aminoglycoside (GNAT)

  • motor spared
  • areflexia & ataxia

conus medullaris

UMN

sensory cortex

lateral medullary syndrome

thalamus (pure sensory stroke - VPL of thalamus)

Tabes Dorsalis
- vibration/ proprioception
- tertiary syphillis
- argyll robertson pupils

Brown-sequard syndrome

Hypocalcemia

STROKE/TIA/migraine

External compression (physical, tumour)

carpal tunnel syndrome

CNS (primary headache/secondary headache)

spinal cord

Higher cortical signs and symptoms

  • aphasia, neglect, abnormalities of graphesthesia, stereognosis, two-point discrimination, extinction

Axonal (length-dependent) neuropathies:

  • DM, leprosy
  • hereditary conditions ((eg, Charcot-Marie-Tooth disease)
  • Amyloidosis (light chain and familial)
  • Vasculitis
  • Uremia
  • Chemo, EtOH
  • paraneoplastic neuropathy
  • nutritional deficiency (vit B2, B6, B12)
  • infections (HBV, HCV, syphillis, HIV, lyme disease)

Hyperventilation/ panic attack

PVD

Carpal tunnel syndrome

  • worse in morning, better with shaking
  • can involve all 5 fingers
  • refer HRM

PSY: https://neurosymptoms.org/en/

  • refer psychology