Numbness & Paraesthesia DDx

Numbness & Paraesthesia – Differential Diagnosis

Common causes

• Anxiety/ Hyperventilation
• Diabetic neuropathy
• Mononeuropathy (e.g. CTS)
• Radiculopathy (e.g. Cervical)
• Migraine with aura
• Herpes Zoster

Must Not Miss

• CVA / TIA
• CNS tumours
• Spinal cord compression
• Multiple sclerosis
• HIV
• Guillain-Barré syndrome

Easily missed

• Peripheral polyneuropathy
  • Diabetic neuropathy
  • Alcohol
  • Vitamin B12 deficiency
  • Metabolic
  • Connective tissue diseases
  • Heavy metals
  • Paraneoplastic syndrome
  • Idiopathic & others

Red flags

• Confusion & loss of consciousness
• Back pain & Loss of bladder/bowel control
• Difficulty walking
• Other neurological symptoms
• Change in vision
• Slurred speech
• Limb weakness
• Chronic progressive symptoms

Investigations to consider

• FBC, CRP/ESR
• U+Es, LFTs, TFTs, Bone profile, Serum glucose, B12 + Folate
• Auto-antibody screen
• Myeloma Screen
• HIV screen
• Toxicology screen
• CXR
• NCS + EMG
• MRI scan (head & spine)
• Lumbar puncture