Sensory disturbances Character: Ask generally Band like Burnig Painful or shooting Location Ask generally Location at onset Side Qualitative Ask generally Affecting daily life Ability to feel Ability to walk Time course Relieving factors: Ask generally Leg elevation Rest Standing Context and aggravating factors Ask generally Bend back Bend knee Context at onset Ideas Injuries Associated features Falls Nausea Pallor Leg pain Weakness Hair changes Nail changes Skin changes Skin lesions Urinary symptoms Altered bowel habits Loss of consciousness Coordination difficulty Medications General history Tests and procedures Past medical history Ask generally Metabolic Autoimmune Neurological disease Cardiovascular disease Family history Social history Diet Exercise Alcohol history Smoking history Patient demographics Recreational drug history Differentials Drug induced: Weakness Medications e.g. amiodarone, hydralazine, statin, nitrous oxide Alcohol history Diabetic neuropathy Distal symmetrical sensory loss Numbness Tingling sensations Dysesthesia -> burning feet syndrome with symptoms that worsen at night Allodynia Hyperesthesia Motor weakness Ataxia Balance issues Falls Skin lesions Urinary symptoms Nausea Altered bowel habits Loss of consciousness Peripheral vascular disease: Pallor Leg pain Foot pain Chest pain Thigh pain Hair changes Nail changes Skin changes Skin lesions Worse with exertion Completely relieved by rest Paraesthesia distal to arterial occlusion Critical limb ischemia -> rest pain lasting for more than 2 weeks, nonhealing ulcers, tissue loss (gangrene) Lumbar spine stenosis: Leg pain Weakness Back pain Urinary symptoms Back pain altered bowel habits Load depended on pain Worsens with walking Unilateral or bilateral gluteal, thigh and calf pain. Relieved by lumbar flexion Unsteady wide based gait Reduced motility of the lower extremities Mild motor weakness and sensory change Abnormal Romberg test Nutritional deficiencies Low vitamin B12 Carpal tunnel syndrome Pain and paraesthesia in the hand and wrists. Pain may extend to arm and shoulder/ Paraesthesia is usually ONLY felt in the fingers. Worse at night Made better by dangling the arm over the side of the bed or shaking the hand -> flick sign. All nerve root, spinal cord and cerebral abnormalities call can cause disturbances in sensation and muscle weakness. KEY NOTES ON DISTURBED SENSATION AND WEAKNESS IN THE LIMBS Pins and needles in the hands or feet -> nerve entrapment or a peripheral neuropathy. Can also result from sensory pathway involvement at any level.