Numbness or altered sensation
Red flags
- Sensory level on the trunk +/- bladder or bowel change = cord compression - MRI whole spine today, dexamethasone if malignant
- Saddle anaesthesia + bilateral sciatica + urinary retention = cauda equina - MRI today
- Rapidly ascending numbness and weakness with areflexia = GBS - serial FVC, not oximetry
- Sudden onset, one side, face + arm + leg = stroke or TIA - code stroke pathway
- Pure sensory stroke = thalamic or internal capsule lacune
- Numbness with fever, back pain and raised inflammatory markers = epidural abscess
- Dissociated sensory loss (pain/temperature lost, proprioception spared) = intramedullary cord lesion until excluded
- New numbness in a patient with cancer = metastasis, leptomeningeal disease, paraneoplastic, or chemotherapy toxicity
- Nitrous oxide use, bariatric surgery, or vegan diet with a spastic-ataxic gait = B12 deficiency - treat before the deficit becomes fixed
- Painless ulceration, burns or Charcot joint - the sensory loss is already dangerous
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