Neuropathic pain
Red flags
- New back pain + bilateral leg symptoms + bladder or bowel change = cauda equina - MRI today
- Thoracic or band-like pain with a sensory level = cord compression - image the whole spine
- Progressive pain + weight loss + night pain + known cancer = metastatic or leptomeningeal disease
- Mononeuritis multiplex - painful, asymmetric, sequential named nerve lesions = vasculitis until proven otherwise; needs urgent immunosuppression, not an outpatient nerve conduction study
- Fever, back pain, raised CRP, IVDU or bacteraemia = epidural abscess/discitis
- New severe facial pain in a patient under 50, bilateral, or with any sensory loss or other cranial nerve sign = **not classical trigeminal neuralgia - MRI**
- Acutely painful, cold, pulseless limb = ischaemia, not neuropathy
- Rapidly progressive painful neuropathy with weight loss - diabetic radiculoplexus neuropathy, vasculitis, paraneoplastic, amyloid, HIV
- Zoster in the V1 dermatome (Hutchinson sign - tip of the nose) -> ophthalmic involvement; same-day ophthalmology
7 more sections, plus exam facts
Every note and exam fact is free for everyone until 9 November - just sign up.
Sign up free