Diffuse Numbness
Age: years old
Gender:
HISTORY:
Presents with a - history of in
Onset was
Pattern
Worsening factors:
Alleviating factors: ,
Associated symptoms: *Try using right-click for negatives*
Contributing factors:
no history of: , , , , ,
no use of: , , ,
no family history of:
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Neck: , , , c-spine
Heart: , ,
Lungs: , ,
Abdomen: , , , , bowel sounds , ,
Skin: on
Extremities: , , cap refill sec, pulses , ,
Neurologic:
- Mental status: , oriented to , speech
- Cranial nerves:
- Strength: except for on ,
- Sensation: to on
- Reflexes: except for on ,
- Cerebellar function: , finger-nose, rapid alternating movements, heel-shin, Romberg , Dix-Hallpike
- Gait: , tandem gait, heel walk and toe walk
ASSESSMENT:
DDx: diabetic neuropathy, alcoholic neuropathy, Guillain-Barré syndrome, Charcot-Marie-Tooth disease, toxic neuropathies (e.g., heavy metal poisoning, medication-induced), vitamin B12 deficiency, HIV-associated neuropathy, amyloid neuropathy, chronic inflammatory demyelinating polyneuropathy (CIDP), hereditary neuropathies, vasculitis-associated neuropathy, hypothyroidism, Lyme disease, sarcoidosis, paraneoplastic syndromes, critical illness polyneuropathy, renal failure, liver disease, nutritional deficiencies, infectious diseases (e.g., leprosy), autoimmune diseases, paraproteinemia (e.g., multiple myeloma), chemotherapy-induced peripheral neuropathy, post-infectious neuropathy
PLAN:
Investigations:
- Blood work: , , , , , , , , , , , , , , , , , , ,
- Nerve conduction study
- EMG
- MRI of the spine
- Lumbar puncture
Treatments:
-
-
- Physical therapy
- Occupational therapy
- Vitamin supplementation
- Optimize glycemic control if diabetic
- Smoking cessation
- Alcohol reduction
Further care:
- Referral to neurologist
- Follow-up in
- Return if symptoms worsen, if new symptoms develop such as muscle weakness or autonomic dysfunction, or if symptoms do not improve with treatment
HISTORY: Associated symptoms: EXAM: Neurologic: ASSESSMENT: PLAN: