Acute Sensory Symptoms

Author: Simon Rinaldi

Sensory symptoms are a result of altered perception of pain, temperature, touch or proprioception. They may be positive (dysaesthesia) or negative (hypoaesthesia). They are commonly, but not invariably, associated with weakness (Chapter 17).
Sensory symptoms can result from pathology anywhere in the nervous system, although disease processes restricted to the muscle, neuromuscular junction, or motor neuron should not produce sensory signs.
Points to bear in mind in the interpretation of the sensory examination are summarized in Box 18.1.

You need to rapidly identify those patients:

The clinical assessment is summarized in Table 18.1. The diagnosis is suggested by characteristics of the symptoms:

Diagnostic tests are directed by the clinical picture, although some tests should be considered for all patients Table 18.4).

Acute stroke and spinal cord/cauda equina syndromes require urgent neuroimaging.
Investigation for syndromes with the potential for both motor and sensory involvement are given in Table 17.4.
With a single focal-onset sensory seizure, MRI is the imaging modality of choice (and can usually be performed as an outpatient) although there may be situations when immediate CT is the more pragmatic choice.

Further management is directed by the working diagnosis.
Sensory symptoms may predispose to injury and falls and these risks need to be evaluated and addressed.
Neuropathic pain is frequent, may respond poorly to standard analgesic preparation, typically requiring neuropathic pain agents such as amitriptyline, gabapentin and/or pregabalin.