Numbness - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:50Z

Strip excess bold

← Revisión anterior		Revisión del 09:26 22 mar 2026
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	[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes — posterior]]		[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes — posterior]]
	*Numbness (paresthesias/hypoesthesia) is a common ED complaint		*Numbness (paresthesias/hypoesthesia) is a common ED complaint
	*Key EM role: distinguish ~~'''~~central causes~~'''~~ (stroke, spinal cord compression) from peripheral causes		*Key EM role: distinguish central causes (stroke, spinal cord compression) from peripheral causes
	*Pattern of numbness is the most important clue to localization		*Pattern of numbness is the most important clue to localization

	==Clinical Features==		==Clinical Features==
	===Localizing by History and Physical===		===Localizing by History and Physical===
	*~~'''~~Distribution~~'''~~: unilateral face + arm + leg = cortical (stroke); bilateral distal = peripheral neuropathy; dermatomal = radiculopathy; stocking-glove = polyneuropathy		*Distribution: unilateral face + arm + leg = cortical (stroke); bilateral distal = peripheral neuropathy; dermatomal = radiculopathy; stocking-glove = polyneuropathy
	*~~'''~~Onset~~'''~~: acute (minutes-hours) = vascular; subacute (days-weeks) = inflammatory; chronic = metabolic/degenerative		*Onset: acute (minutes-hours) = vascular; subacute (days-weeks) = inflammatory; chronic = metabolic/degenerative
	*~~'''~~Associated weakness~~'''~~: combined motor + sensory = more concerning for central or cord lesion		*Associated weakness: combined motor + sensory = more concerning for central or cord lesion
	*~~'''~~Sensory level~~'''~~: band-like numbness at a specific dermatome level = spinal cord pathology		*Sensory level: band-like numbness at a specific dermatome level = spinal cord pathology

	===Red Flags===		===Red Flags===
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	===Central===		===Central===
	*~~'''~~[[Stroke]]/[[TIA]]~~'''~~: acute onset, unilateral, often with other deficits		*[[Stroke]]/[[TIA]]: acute onset, unilateral, often with other deficits
	*~~'''~~[[Spinal cord compression]]~~'''~~: bilateral, sensory level, weakness (see [[Epidural compression syndromes]])		*[[Spinal cord compression]]: bilateral, sensory level, weakness (see [[Epidural compression syndromes]])
	*~~'''~~[[Transverse myelitis]]~~'''~~, [[MS]]		*[[Transverse myelitis]], [[MS]]

	===Peripheral===		===Peripheral===
	*~~'''~~[[Guillain-Barré syndrome]]~~'''~~: ascending weakness + paresthesias, areflexia		*[[Guillain-Barré syndrome]]: ascending weakness + paresthesias, areflexia
	*~~'''~~Radiculopathy~~'''~~: dermatomal, often with pain		*Radiculopathy: dermatomal, often with pain
	*~~'''~~Diabetic neuropathy~~'''~~: distal, symmetric, stocking-glove		*Diabetic neuropathy: distal, symmetric, stocking-glove
	*~~'''~~Carpal tunnel / ulnar neuropathy~~'''~~: specific nerve distribution		*Carpal tunnel / ulnar neuropathy: specific nerve distribution
	*~~'''~~[[Cauda equina syndrome]]~~'''~~: saddle anesthesia, urinary retention, bilateral leg symptoms		*[[Cauda equina syndrome]]: saddle anesthesia, urinary retention, bilateral leg symptoms

	==Evaluation==		==Evaluation==
	*Thorough neurologic exam: sensory testing (light touch, pinprick, proprioception), motor strength, reflexes, gait		*Thorough neurologic exam: sensory testing (light touch, pinprick, proprioception), motor strength, reflexes, gait
	*~~'''~~Acute unilateral~~'''~~: CT/CTA head → stroke protocol		*Acute unilateral: CT/CTA head → stroke protocol
	*~~'''~~Bilateral with sensory level~~'''~~: emergent MRI spine (cord compression)		*Bilateral with sensory level: emergent MRI spine (cord compression)
	*~~'''~~Saddle anesthesia~~'''~~: emergent MRI lumbar spine, bladder scan for post-void residual		*Saddle anesthesia: emergent MRI lumbar spine, bladder scan for post-void residual
	*~~'''~~Ascending weakness~~'''~~: LP for GBS (albuminocytologic dissociation), respiratory monitoring		*Ascending weakness: LP for GBS (albuminocytologic dissociation), respiratory monitoring
	*[[BMP]], [[CBC]], [[glucose]], [[TSH]], B12 for polyneuropathy workup (can be outpatient)		*[[BMP]], [[CBC]], [[glucose]], [[TSH]], B12 for polyneuropathy workup (can be outpatient)

	==Management==		==Management==
	*~~'''~~Stroke~~'''~~: activate stroke protocol (see [[Stroke]])		*Stroke: activate stroke protocol (see [[Stroke]])
	*~~'''~~Cord compression~~'''~~: IV [[dexamethasone]], emergent neurosurgery/oncology, emergent MRI		*Cord compression: IV [[dexamethasone]], emergent neurosurgery/oncology, emergent MRI
	*~~'''~~Cauda equina~~'''~~: emergent MRI, surgical consultation		*Cauda equina: emergent MRI, surgical consultation
	*~~'''~~GBS~~'''~~: ICU if respiratory compromise, IVIG or plasmapheresis, neurology consultation		*GBS: ICU if respiratory compromise, IVIG or plasmapheresis, neurology consultation
	*~~'''~~Peripheral neuropathy~~'''~~: outpatient workup unless acute/progressive		*Peripheral neuropathy: outpatient workup unless acute/progressive
	*~~'''~~Radiculopathy~~'''~~: pain management, outpatient follow-up unless red flags		*Radiculopathy: pain management, outpatient follow-up unless red flags

	==Disposition==		==Disposition==

Danbot: Expanded with concise EM-focused content: localization-based approach, red flags, central vs peripheral, management by cause, disposition

2026-03-21T00:42:57Z

Expanded with concise EM-focused content: localization-based approach, red flags, central vs peripheral, management by cause, disposition

Show changes

Rossdonaldson1 at 19:42, 22 October 2025

2025-10-22T19:42:33Z

← Revisión anterior		Revisión del 19:42 22 oct 2025
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	==Background==		==Background==
	[[File:~~Spinal cord tracts~~.~~svg~~\|thumb\|~~Spinal cord tracts~~]]		[[File:23-Sensory-Homonculus.png\|thumb\|Sensory Homonculus - courtesy AnatomyZone.com]]
	[[File:Dermatomes and cutaneous nerves - anterior.png\|thumb\|Dermatomes and cutaneous nerves - anterior]]		[[File:Dermatomes and cutaneous nerves - anterior.png\|thumb\|Dermatomes and cutaneous nerves - anterior]]
	[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes and cutaneous nerves - posterior]]		[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes and cutaneous nerves - posterior]]

Rossdonaldson1: /* Background */

2025-10-22T19:25:19Z

Background

← Revisión anterior		Revisión del 19:25 22 oct 2025
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	==Background==		==Background==
			[[File:Spinal cord tracts.svg\|thumb\|Spinal cord tracts]]
			[[File:Dermatomes and cutaneous nerves - anterior.png\|thumb\|Dermatomes and cutaneous nerves - anterior]]
			[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes and cutaneous nerves - posterior]]
			[[File:Cutaneous innervation of the upper limb.svg\|thumb\|Cutaneous innervation of the upper limb]]
			[[File:Lower limb peripheral innervation.png\|thumb\|Lower limb peripheral innervation]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2025-04-23T22:19:30Z

Differential Diagnosis

← Revisión anterior		Revisión del 22:19 23 abr 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Peripheral ~~nerve syndromes~~}}		{{Peripheral neuropathy DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2025-04-23T22:19:07Z

Differential Diagnosis

← Revisión anterior		Revisión del 22:19 23 abr 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Peripheral nerve syndromes}}

	==Evaluation==		==Evaluation==

Mholtz at 08:39, 14 August 2017

2017-08-14T08:39:06Z

← Revisión anterior		Revisión del 08:39 14 ago 2017
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	==Background==		==Background==


	==Clinical Features==		==Clinical Features==

	~~===Localizing the problem by history & physical<ref>~~

	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</ref>===		===Localizing the problem by history & physical<ref>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</ref>===
	*Distribution of symptoms		*Distribution of symptoms
	**Right vs. left		**Right vs. left
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	==Differential Diagnosis==		==Differential Diagnosis==


	==Evaluation==		==Evaluation==
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	==Management==		==Management==


	==Disposition==		==Disposition==


	==See Also==		==See Also==
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	==External Links==		==External Links==


	==References==		==References==
	<references/>		<references/>

			[[Category:Symptoms]]

Rossdonaldson1: /* Evaluation */

2017-08-12T18:36:42Z

Evaluation

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 |-
 | '''Nerve'''||Unilateral or bilateral||Possible||Yes
 |}

Rossdonaldson1: /* Evaluation */

2017-08-12T18:28:56Z

Evaluation

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	\| align="center" style="background:#f0f0f0;"\|'''Pain'''		\| align="center" style="background:#f0f0f0;"\|'''Pain'''
	\|-		\|-
	\| '''Brain'''\|\|Unilateral\|\|Often\|\|no		\| '''Brain'''\|\|Unilateral\|\|Often\|\|No
	\|-		\|-
	\| '''Spinal cord'''\|\|Bilateral\|\|No\|\|Possible		\| '''Spinal cord'''\|\|Bilateral\|\|No\|\|Possible

Rossdonaldson1: /* Evaluation */

2017-08-12T18:28:44Z

Evaluation

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	==Evaluation==		==Evaluation==
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|''''''		\| align="center" style="background:#f0f0f0;"\|'''Region'''
	\| align="center" style="background:#f0f0f0;"\|'''Distribution'''		\| align="center" style="background:#f0f0f0;"\|'''Distribution'''
	\| align="center" style="background:#f0f0f0;"\|'''Facial Involvement'''		\| align="center" style="background:#f0f0f0;"\|'''Facial Involvement'''
	\| align="center" style="background:#f0f0f0;"\|'''Pain'''		\| align="center" style="background:#f0f0f0;"\|'''Pain'''
	\|-		\|-
	\| Brain\|\|Unilateral\|\|Often\|\|no		\| '''Brain'''\|\|Unilateral\|\|Often\|\|no
	\|-		\|-
	\| Spinal cord\|\|Bilateral\|\|No\|\|Possible		\| '''Spinal cord'''\|\|Bilateral\|\|No\|\|Possible
	\|-		\|-
	\| Nerve root\|\|Unilateral\|\|No\|\|Yes		\| '''Nerve root'''\|\|Unilateral\|\|No\|\|Yes
	\|-		\|-
	\| Nerve\|\|Unilateral or bilateral\|\|Possible\|\|Yes		\| '''Nerve'''\|\|Unilateral or bilateral\|\|Possible\|\|Yes
	\|}		\|}