Deafness is often accompanied by abnormal tingling sensations (pinholes) which are not related to a sensory stimulus (paresthesia). Other manifestations (eg. B. pain, weakness in limbs, not sensory cranial nerve disorder) may also be present depending on the cause.
The term “numbness” can be used by patients to describe various symptoms, incl. Loss of sensation, discomfort and weakness or paralysis. However, deafness is actually the part (hypoesthesia) or complete (anesthesia) loss of sensations. Deafness, the 3 main sensory modality light touch, pain and temperature sense, position and vibration sense or equal concern or different extents. Deafness is often accompanied by abnormal tingling sensations (pinholes) which are not related to a sensory stimulus (paresthesia). Other manifestations (eg. B. pain, weakness in limbs, not sensory cranial nerve disorder) may also be present depending on the cause. Adverse effects of chronic numbness include: difficulty walking or driving Increased risk of falls Furthermore, infections, diabetic foot ulcers and injuries are overlooked, which entails a delayed treatment by itself. Pathophysiology anatomy sensory areas in the brain associated with the cranial nerves or sensory pathways in the spinal cord. Sensory nerve fibers join to the rear roots and enter (except C1 spinal nerve) in the respective spinal cord segment. The sensory posterior roots 30 form the spinal nerves along with the corresponding motor anterior roots. Branches of the cervical and lumbosacral nerve roots unite further distally, form plexus and then branch into nerve trunks. The intercostal nerves do not form plexus; they correspond to their source segment in the spinal cord. As peripheral nerve of the part of the spinal nerves is referred to, which is distal to the nerve root and plexus. Spinal nerve nerve roots of the most distal spinal cord segments drawn within the spine below the end of the spinal cord, forming the cauda equina. The cauda equina supplies the sensor of legs, shame, perineal and sacral region (breeches range) as well as the muscles of the pelvic floor. The spinal cord is divided into functional segments (levels) corresponding to approximately the 31 Spinalnervenwurzelpaaren. The area of ??skin, which is primarily supplied from a specific spinal nerves, the dermatome that corresponds to this spinal cord segment (Sensory dermatomes.). Sensory dermatomes. (Drawn by JJ Keegan, Garrett FD, Anatomical Record 102: 409-437, 1948; used with permission from The Wistar Institute, Philadelphia, Pennsylvania). Mechanisms numbness may stem from dysfunctions that may be located anywhere on the way from the sensory receptors up to the cortex and there. Common mechanisms are: ischemia (. Z B.Infarkt in the brain, spinal cord infarction, vasculitis) Demyelinating diseases (eg multiple sclerosis, Guillain-Barre syndrome.) Mechanical compression of nerves (eg by tumors or herniated disc [. nucleus pulposus], carpal tunnel syndrome) infections (eg. as HIV, leprosy) toxins or drugs (e.g., as heavy metals, certain chemotherapeutic agents), metabolic disorders (eg., diabetes, chronic kidney disease, thiamine or vitamin B12 deficiency) immune-mediated diseases (z. B. post-infectious inflammation such as transverse myelitis) Degenerative diseases (eg. as hereditary neuropathies) etiology numbness have many causes. Despite some overlap, the classification of the causes for the numbness pattern can be helpful (see Table: Causes of numbness). Causes of numbness due suspects findings Diagnostic procedure Unilateral deafness of both limbs (Hemihypästhesie) * Cortical dysfunction (eg., Stroke, cancer, multiple sclerosis, degenerative brain disease) Partial loss of face and body sensations plus loss of cortical sensory (eg. B. Agraphästhesie, astereognosis, absorbance) Usually, not sensory neurological deficits (eg. B. weakness, hyperreflexia, ataxia) MRI or CT Dysfunction of the upper brainstem or thalamus (eg. As stroke, tumor, abscess) Partial loss of facial and body sensations often cranial nerve deficits (z. B. oculomotor palsy on the contralateral deafness side in some insults in the upper brainstem) MRT (preferably of the lower in brainstem dysfunction) or CT dysfunction brain stem ( z., stroke, tumor, degenerative brain diseases) loss of facial and body sensations on the respective contralateral side (crossed face-body distribution) Often cranial nerve deficits MRT Bilateral numbness in the limbs or torso Transverse myelopathy (z. As spinal cord compression, transverse myelitis) loss of sensory, motor and reflex function below a certain spine segment autonomic dysfunction (e.g., intestine, bladder and erectile dysfunction;. Anhidrosis) MRT dysfunction in the posterior columns (e.g., multiple sclerosis, vitamin B12. deficiency, tabes dorsalis) Dysproportionierter loss of vibration and position sense in vitamin B12 deficiency, bilateral and symmetrical findings (usually due to spinal cord dysfunction, although peripheral neuropathy may be involved) MRI vitamin B12 levels, cell count and protein determination and blood tests for syphilis in the CSF Compr ession of the cauda equina and cauda equina syndrome called (z. For example, by disc herniation or metastases in the spinal cord or spinal column) numbness perineum (breeches area) primarily affect Often urinary retention, fecal incontinence and / or loss of Sphinkterreflexe (z. B. anal reflex, Bulbocavernosusreflex) MRT polyneuropathies such as axonal polyneuropathy (z. B. associated with drugs, diabetes, chronic kidney disease, metabolic disorders) demyelinating polyneuropathy (z. B. Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, toxic or drug-induced demyelinating polyneuropathy) Bilateral, largely symmetrical, usually distal paresthesias and sensory loss (hosiery glove distribution) Sometimes weakness and Hypo reflexie (eg. B. Electro-diagnostic tests by the suspected fault founded in demyelinating polyneuropathy) laboratory tests Multiple mononeuropathy-also mononeuritis multiplex called (z. B. associated with connective tissue disease, infection or metabolic disorders such as diabetes) numbness with or without pain usually motor Dfizite and reflexes in the innervation of several peripheral nerves, which may affect certain nerve sequentially (clinical distinction between a stocking-glove distribution may be impossible) electro-diagnostic tests and laboratory tests according to the suspected cause numbness in a He Teilextremität radiculopathy (eg. B. disc herniation, bone compression by osteoarthritis or rheumatoid arthritis, carcinomatous meningitis, infectious Radikulopatie) pain (sometimes like an electric shock), sensory, and often motor and / or reflex deficits in Innervationsgebet a nerve root (see Table: Symptoms often radiculopathy, on the level of spinal segment) the pain is by moving the vertebra or a Valsalva maneuver may worsen MRI or CT Sometimes electrodiagnostic studies plexopathy (z. B. brachial or lumbar plexopathy, brachial neuritis, shoulder girdle compression syndrome) sensory loss, pain and motor deficits in a Teilextremität ( sometimes in the majority of the limb), one in its spread over Mononeuropathy or Radikulopathe go Electro-diagnostic tests MRI, with the exception of trauma or suspected brachial neuritis as the cause Simple mononeuropathy (eg. B. carpal, cubital, radial and tarsal tunnel syndrome; ulnar, radial and peroneal nerve palsies) Numbness (with or without pain) and motor and reflex deficits in Innervationsgebet a single peripheral nerve Clinical examination Sometimes electrodiagnostic studies * Only one leg can be affected; the body can be affected. Conus medullaris syndrome is a Querschnittsmyelopathie approximately at the level L1. Findings similar to those of cauda equina syndrome. The findings may occur on both sides. OA = osteoarthritis. Rating Since numbness can be caused by a number of disorders, then a sequential evaluation. First, the numbness distribution pattern for the localization of the beiteiligten part of the nervous system is used. Other clinical features-especially the beginning, associated neurological symptoms and complaints and symmetry restrict the differential diagnosis and thus lead to further questions and tests to detect specific causal disorders. Although in practice certain elements of the history are normally selectively inquired (z. B. typical stroke patients are asked not in detail and by risk factors for polyneuropathy vice versa), are here presented several potentially relevant medical history questions to the information. History In the history taking to the existing Erankung the patient should be asked with an open question is to describe the numbness. Symptom onset, duration and course should be determined. Most important are the location of deafness Associated neurological symptoms (eg. As paresis, dysaesthesia, sphincter dysfunction such as incontinence or retention, dysphasia, visual loss, diplopia, dysphagia, cognitive decline). Possible causes for (such. As compression of an extremity, trauma, recent previous history of intoxication, poor sleeping position, symptoms of infection). In reviewing the organ systems symptoms should causal diseases are identified. Some examples are back and / or neck pain: Osteoarthritis- or RA-associated herniation or spinal cord compression fever and / or rash: Infectious neuropathy, infectious radiculopathy, brain infection or rheumatic disorders Headache: brain tumor, stroke or encephalopathy joint pain: rheumatic diseases Malnutrition vitamin B12 deficiency Excessive intake of strong mercury-contaminated seafood: polyneuropathy the medical history of known disorders should be detected, which can cause numbness, in particular the following: diabetes or chronic kidney disease: polyneuropathy infections such as HIV, syphilis or Lyme disease: infectious peripheral neuropathy or brain infection CAD, atrial fibrillation, atherosclerosis or smoking:, stroke l osteoarthritis or RA: radiculopathy The family history should include information on all family neurological disorders. The drug and social history should the use of all drugs and substances and occupational exposure to toxins einschließen.Körperliche investigation a complete neurological examination is performed with emphasis on the localization and neurological areas derReflex-, motor and sensory function deficits. Generally, the reflex test is the most objective method of examination, the sensory tests are the most subjective; sensory failures can often not precisely defined werden.Warnhinweise The following findings are of particular importance: Sudden onset of symptoms (e.g., within minutes or hours). Sudden or rapid onset of weakness (e.g., within hours or days.) dyspnea sign of cauda equina or cone syndrome (z. B. saddle anesthesia, incontinence, loss of Analreflexes) Neurological deficits below a spinal segment Sensory failure interpretation of the findings the anatomical symptom pattern sets (contralateral ipsilateral or) both on the face and on the body but the location of the lesion close, is often non-specific, general numbness a Teilextremität: lesion of the peripheral nervous system sided deafness both extremities (Hemihypästhesie) (with or without participation of R umpfes): brain lesion bilateral deafness below a certain dermatome: Querschnittsmyelopathie (spinal cord) Bilateral numbness that does not correspond to a particular dermatome: polyneuropathy, multiple mononeuropathy or flick shaped distributed spinal cord or brain disease More specific are localization pattern: stocking-glove distribution: With minimal or lack of motor signs is present axonal polyneuropathy in general; together with weakness and spasticity (. eg hyperreflexia, increased tone, Plantarextension) is sometimes a cervical spondylosis, demyelinating polyneuropathy or demyelinating spinal cord localization in Einzeldermatom: Nervenwurzelläsion (radiculopathy) Einzelextremität, more than one nerve or a nerve root are affected : plexus lesion (plexopathy) multiple, related or separate peripheral nerve: peripheral neuropathy sensory loss with a disproportionate influence on position and vibration: dysfunction of the rear train or demyelinating peripheral neuropathy localization in the breeches range: Conus medullaris syndrome or compression of cauda equina (cauda equina syndrome) Crossed face-body distribution (ie, face and body are affected on different pages): lesion of the lower brain stem Ipsi lateral face Body Distribution: lesion of the upper brainstem, thalamus or cortex findings that indicate the involvement of several anatomical areas (eg. As brain and spinal cord lesions), suggest the presence of more than one lesion (eg. As multiple sclerosis, metastatic tumors, multifocal degenerative brain or spinal cord disease) or more than one cause of disease. The pace at the onset of symptoms helps in accepting a likely pathophysiology: Almost instantly (usually seconds, sometimes minutes): Ischemic or traumatic hours to days: Infectious or toxic-metabolic days to weeks: infectious, toxic-metabolic or immune mediated weeks to months : Neoplastic or degenerative the degree of symmetry also provides clues. A highly symmetrical involvement indicated (metabolic, toxic, drug-associated, infectious or post-infectious eg., Vitamin deficiency) to a systemic cause out. A clearly asymmetrical involvement suggests a structural cause close (eg., Tumor, trauma, stroke, peripheral plexus or nerve compression, focal or multifocal degenerative disease). After determining the location of the lesion, their onset and the degree of symmetry to the list of possible diagnoses shortened so that the focus on clinical features that differentiate between them feasible (see Table: Causes of numbness). Indicated such. As the initial assessment on axonal polyneuropathy out is directed further evaluation on the properties of many potential drugs, toxins and disorders that cause these polyneuropathy können.Testing tests are generally required, except when there is a clinically obvious diagnosis and choosing a conservative treatment (eg. as in some cases of carpal tunnel syndrome, with herniated or traumatic neurapraxia). The choice of tests is based on the anatomical location of the suspected cause: Peripheral nerves or nerve roots: examination of nerve conduction and electromyography (electrodiagnostic testing) brain or spinal cord: MRI Electro-diagnostic tests can be used to differentiate between neuropathies, plexopathies (lesions distal to the nerve root) and proximal lesions (z. B. radiculopathy) and contribute (axonal z. B., demyelinating, hereditary, acquired) between different types of polyneuropathies. If the clinical findings suggest a structural lesion of the brain or spinal cord or radiculopathy, usually an MRI is indicated. CT is usually the second choice, but it can be especially helpful if an MRI is not available quickly enough (eg. As in emergencies). After location of the lesion subsequent tests can focus on specific disorders (eg. As metabolic, infectious, toxic, autoimmune or other systemic diseases). The results show for. B. polyneuropathy, any subsequent tests typically include blood count, electrolytes, renal function tests, TPHA screening test and measurements of fasting plasma glucose, HbA1C, vitamin B12, folic acid and TSH. Some investigators include a serum electrophoresis with one. Treatment Treatment depends on the disorder that is causing the numbness. Patients without sensation in the feet, v. a. with impaired circulation, should take precautions to prevent injuries and to recognize them. When walking socks and well-fitting shoes are required; before wearing must be checked whether hidden foreign objects in your shoes. The feet should be examined frequently for ulcers and signs of infection. Patients with insensitive hands or fingers may have hot or handling careful sharp objects. Patients with diffuse dysesthesia or failure of the position sense should be directed to gait training to a physiotherapist. Precautions to prevent falls should be taken. Driving ability should be monitored. Key points Use an open question, which you ask the patient to describe their deafness. The anatomical patterns and the timing of the symptoms helps narrow down the possible diagnoses. Pull deafness a Teilextremität the lesion of peripheral nerves, plexus, or nerve root into consideration. Are numb on one side both limbs, with or without numbness of the hull on the same side, consider a brain injury. In bilateral numbness below a certain spinal segment, particularly with motor and reflex deficits, you expect a transverse myelopathy. Corresponds bilateral deafness is not a spinal cord segment, take a polyneuropathy, multiple mononeuropathy or flick shaped distributed spinal cord or brain lesion. Shows the numbness a stocking-glove distribution, consists of V. a. axonal polyneuropathy. In almost sudden deafness without trauma, acute ischemic event is likely. Pull electrodiagnostic studies in V. a. Causes the peripheral nervous system into consideration, and an MRI in causes in the CNS.