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


Region Distribution Facial Involvement Pain
Spinal cordBilateralNoPossible
Nerve rootUnilateralNoYes
NerveUnilateral or bilateralPossibleYes
Cause Acute (Days) Chronic (Weeks-Months)
ImmuneGuillain-Barre & variants, vasculitisChronic demylinating neuropathy
ToxinsBotulism, buckthorn, diphtheria, tick, arsenic, organophosphates, thallium, vacorHeavy metals, environmental chemicals
DrugsCaptopril, gangliosides, gold, nitrofurantoin, suramin, zimeldinechemotheraputic agents
MetabolicPorphyriaPorphyria, diabetes
NutritionalVitamin toxicity or deficiency
HereditaryHereditary motor and sensory neuropothy, hereditary sensory neuropathy



See Also


  1. Rosenfeld J, Martin RA, Bauer DW. "Chapter Three - Numbness: A Practical Guide for Family Physicians." American Academy of Neurology.
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