TAILIEUCHUNG - Chapter 025. Numbness, Tingling, and Sensory Loss (Part 1)

Harrison's Internal Medicine Chapter 25. Numbness, Tingling, and Sensory Loss Numbness, Tingling, and Sensory Loss: Introduction Normal somatic sensation reflects a continuous monitoring process, little of which reaches consciousness under ordinary conditions. By contrast, disordered sensation, particularly when experienced as painful, is alarming and dominates the sufferer's attention. Physicians should be able to recognize abnormal sensations by how they are described, know their type and likely site of origin, and understand their implications. Pain is considered separately in Chap. 12. Positive and Negative Symptoms Abnormal sensory symptoms may be divided into two categories, positive and negative. . | Chapter 025. Numbness Tingling and Sensory Loss Part 1 Harrison s Internal Medicine Chapter 25. Numbness Tingling and Sensory Loss Numbness Tingling and Sensory Loss Introduction Normal somatic sensation reflects a continuous monitoring process little of which reaches consciousness under ordinary conditions. By contrast disordered sensation particularly when experienced as painful is alarming and dominates the sufferer s attention. Physicians should be able to recognize abnormal sensations by how they are described know their type and likely site of origin and understand their implications. Pain is considered separately in Chap. 12. Positive and Negative Symptoms Abnormal sensory symptoms may be divided into two categories positive and negative. The prototypical positive symptom is tingling pins-and-needles other positive sensory phenomena include altered sensations that are described as pricking bandlike lightning-like shooting feelings lancinations aching knifelike twisting drawing pulling tightening burning searing electrical or raw feelings. Such symptoms are often painful. Positive phenomena usually result from trains of impulses generated at sites of lowered threshold or heightened excitability along a peripheral or central sensory pathway. The nature and severity of the abnormal sensation depend on the number rate timing and distribution of ectopic impulses and the type and function of nervous tissue in which they arise. Because positive phenomena represent excessive activity in sensory pathways they are not necessarily associated with a sensory deficit loss on examination. Negative phenomena represent loss of sensory function and are characterized by diminished or absent feeling often experienced as numbness and by abnormal findings on sensory examination. In disorders affecting peripheral sensation it is estimated that at least half the afferent axons innervating a given site are lost or functionless before a sensory deficit can be demonstrated by clinical

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