Derick Mussen Healthcare

Clinical Features

Site of Lesion

Possible Causes1

Localized sensory disturbance (not in a dermatomal or peripheral nerve distribution)2

Cutaneous nerves/ receptors

Skin lesions, scars, lepromatous leprosy (dissociated sensory deficit3 distally in the limbs, tip of nose, external ear)

Often pain and paresthesia at first, then sensory deficit, in a distribution depending on the site of the lesion

Distal peripheral nerve

Mononeuropathy (compression, tumor), mononeuritis multiplex (involvement of multiple peripheral nerves by vasculitis, diabetes mellitus, etc.)

Distal symmetrical sensory disturbances

Distal peripheral nerves

Polyneuropathy (diabetes mellitus, alcohol, drug/toxic, Guillain-Barre syndrome)

Bilateral symmetrical or asymmetrical thigh pain

Peripheral nerves, lumbar plexus

Diabetes mellitus

Multiple sensory and motor deficits in a single limb

Plexus

Trauma, compression, infection, ischemia, tumor, metabolic disturbance

Unilateral or bilateral, monoradicular or polyradicular deficits

Nerve root

Herniated disk, herpes zoster, Guillain-Barre syndrome, tumor, carcinomatous meningitis, paraneoplastic syndrome

Spinal ataxia, incomplete or complete cord transection syndrome (p. 48)

Spinal cord

Vascular, tumor, inflammatory/multiple sclerosis, hereditary, metabolic disease, trauma, malformation

Loss of position and vibration sense in the upper limbs and trunk, Lhermitte's sign

Craniocervical junction

Tumor, basilar impression

Contralateral dissociated or crossed sensory deficit (p. 70 ff)

Brainstem

Vascular, tumor, multiple sclerosis

Contralateral paresthesia and sensory deficits, pain, loss of vibration sense

Thalamus

Vascular (p. 170), tumor, multiple sclerosis

Paresthesia, contralateral sensory deficits (astereognosis, loss of position sense and two-point discrimination, inability to localize a stimulus, agraphesthesia)

Postcentral cortex

Vascular, tumor, trauma