Sensory Impairment

EXAMINATION OF THE SENSORY SYSTEM: see page 21

CLINICAL FEATURES

Sensory disturbance may result in:

NEGATIVE symptoms: 'a loss of feeling'

POSITIVE symptoms: 'a pins and needles sensation'

'a burning feeling'.

Lesions of the PERIPHERAL NERVES or NERVE ROOTS may produce 'negative' or 'positive' symptoms.

DORSAL COLUMN lesions -

produce a discriminatory type of sensory loss.

- impaired two point discrimination

- astereognosis (failure to discriminate objects held in the hand).

- sensory ataxia (disturbed proprioception).

SPINOTHALAMIC TRACT lesions -seldom produce pain but usually a lack of awareness of pain and temperature. This may result in:

- trophic changes: cold blue extremities hair loss brittle nails

- painless burns

- joint deformation (Charcot's joints).

Lesions of the PARIETAL CORTEX also produce a discriminatory type of sensory loss. Minor lesions produce sensory inattention (perceptual rivalry) - with bilateral simultaneous limb stimulation, the stimulus is only perceived on the unaffected side.

LESION LOCALISATION

The pattern of the sensory deficit aids lesion localisation.

Sensory deficit

HEMI SENSORY LOSS

HEMI SENSORY LOSS

Useful localising features (if present)

' 'Discriminatory' sensory deficit. Sensory inattention

(perceptual rivalry) Only minimal pain and temperature loss

{or selective deficit in face, arm, trunk or leg.

{Loss of all sensory modalities including pain and temperature in the face, arm, trunk and leg.

Lesion site

LESION OF CONTRALATERAL PARIETAL

LESION OF CONTRALATERAL PARIETAL

CONTRALATERAL THALAMIC LESION

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