EpistemisHypoalgesia
Specialty: Neurology.
Why it occurs
- Peripheral small fiber sensory-motor polyneuropathy (diabetic, amyloid)
- Cervical or thoracic syringomyelia (selective loss of suspended pain sensitivity)
- Autosomal hereditary sensory neuropathy (congenital pain insensitivity syndrome with anhidrosis)
- Anterolateral spinothalmic tract lesion in the brainstem or spinal cord
- Contralateral thalamic stroke
Initial workup
Prick sensitivity assessment using a standardized disposable sharp object; quantitative thermal studies if isolated involvement of fine fibers is suspected; electromyography and nerve conduction velocity; MRI of the neuraxis if the distribution is centromedullary or hemi-corporal.
red flags
Hypoalgesia that progresses to painful anesthesia in a lower extremity associated with the appearance of painless and infected trophic ulcers on the sole of the foot, which exposes the patient to silent osteomyelitis, gangrene and indication for amputation (severe neuropathic diabetic foot).
Standard management
- Local preventive treatment with moisturizing creams, specific orthopedic footwear and daily foot check-ups
- Rigorous glycemic control in diabetes
- B complex supplementation in deficiency neuropathies.
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