Sensory Assessment
February 15th, 2021
Overview
Sensation is a key aspect of the nervous system, and includes many different modalities. By thoroughly assessing the pattern of sensory loss it is possible to characterise and localise a central or peripheral nervous lesion.
Sensory Modalities
- Dorsal column pathway - proprioception, vibration sensation, soft touch
- Spinothalamic pathway - pain sensation, temperature sensation, soft touch
Causes of Sensory Loss
Central Nervous System
- Brain lesion - ischaemia, haemorrhage, tumour, trauma, encephalitis, vasculitis, demyelination
- Spinal cord lesion - infarct, haemorrhage, abscess, transverse myelitis
Peripheral Nervous System
- Nerve root pathology - trauma, radiculopathy, neoplasm
- Brachial plexopathy - trauma, tumour, brachial neuritis
- Focal peripheral nerve pathology - trauma, entrapment, focal ischaemia, sarcoidosis, tumour
- Mononeuritis multiplex - vasculitis, diabetic neuropathy, Lyme disease, leprosy, paraneoplastic, amyloidosis, sarcoidosis
- Peripheral polyneuropathy - diabetic neuropathy, hypothyroidism, B12 deficiency, alcohol, paraneoplastic, Guillain-Barre, CIDP
Other
- Poor compliance with examination
Interpretation
- Sensory loss affecting an entire limb or entire side - likely due to central pathology
- Sensory loss affecting a single dermatome - likely due to spinal nerve root pathology
- Sensory loss affecting a single peripheral nerve distribution - likely due to a focal peripheral nerve palsy
- Sensory loss affecting multiple peripheral nerve distributions - potentially due to a brachial plexus lesion, or mononeuritis multiplex
- Distal sensory loss (glove and stocking distribution) - suggests a peripheral polyneuropathy
- Isolated dorsal column loss (impaired proprioception and vibration sensation with intact pain and temperature sensation) - suggests peripheral demyelination, e.g. Guillain-Barre, CIDP
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