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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
Brain Unilateral Often No
Spinal cord Bilateral No Possible
Nerve root Unilateral No Yes
Nerve Unilateral or bilateral Possible Yes
Cause Acute (Days) Chronic (Weeks-Months)
Immune Guillain-Barre & variants, vasculitis Chronic demylinating neuropathy
Toxins Botulism, buckthorn, diphtheria, tick, arsenic, organophosphates, thallium, vacor Heavy metals, environmental chemicals
Drugs Captopril, gangliosides, gold, nitrofurantoin, suramin, zimeldine chemotheraputic agents
Metabolic Porphyria Porphyria, diabetes
Nutritional Vitamin toxicity or deficiency
Hereditary Hereditary motor and sensory neuropothy, hereditary sensory neuropathy



See Also

External Links


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