EpistemisHypoesthesia
Specialty: Neurology.
Why it occurs
- Symmetrical distal peripheral polyneuropathy (typically diabetic or toxic-nutritional)
- Peripheral nerve compression (e.g., median nerve in the carpal tunnel, ulnar nerve in the elbow)
- Active compressive radiculopathy (herniated disc with involvement of the dermatomal sensitive root)
- Ischemic or hemorrhagic stroke in the territory of the primary somatosensory cortex or thalamus
- Demyelinating plaque in the spinal cord or brain stem (multiple sclerosis)
Initial workup
Detailed sensory neurological examination that defines whether the distribution is dermatomic, glove and sock (polyneuropathy), peripheral, truncal, or central in origin; electromyography and nerve conduction velocities; brain or spinal cord MRI according to the clinically determined sensory cut-off level.
red flags
Sudden onset hypoesthesia that affects half of the body (hemibody, including face), especially if it is associated with loss of strength, visual or ocular alteration, or difficulty uttering or understanding language, suggestive of acute stroke of ascending sensory pathways.
Standard management
- Treatment of the underlying causal pathology
- Thioctic acid / Alpha lipoic — 600 mg/day orally on an empty stomach for symptomatic diabetic polyneuropathy
- Vitamin B complex — B1, B6, B12, useful in proven deficiency neuropathies
- Physiotherapy and occupational therapy for sensory retraining and prevention of trophic lesions due to lack of sensitivity.
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
- 4