EpistemisDistal sensory anesthesia
Specialty: Neurology.
Why it occurs
- Severe diabetic neuropathy of thick and fine fibers
- Advanced uremic polyneuropathy in dialysis patients
- Primary or heredofamilial systemic amyloidosis
- Severe deficiency polyneuropathy (vitamin B12 or folic acid deficiency, chronic alcoholism)
- Toxicity due to heavy metals (lead, arsenic, mercury) or oncodrugs (chemotherapy with cisplatin or vincristine)
Initial workup
Electromyography (EMG) and nerve conduction velocity (NCV) to characterize the axonal or demyelinating pattern of neuropathy; determination of serum levels of lead, arsenic, blood glucose, glycosylated hemoglobin, vitamin B12, serum protein electrophoresis and immunofixation (rule out monoclonal gammopathy).
red flags
Bilateral distal anesthesia of subacute onset (weeks) associated with symmetrical motor weakness for ankle dorsiflexion and unstable gait with frequent falls in the dark (a sign of severe proprioceptive loss).
Standard management
- Intensive treatment of the underlying cause — strict glycemic control, adequate dialysis, chelation if appropriate
- Vitamin B complex in deficiency cases
- Proprioceptive balance physiotherapy and rigorous education on anesthetic foot care to avoid silent trophic ulcers.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3