Dysesthesia is an abnormal sensation of pain, itching, burning, or other discomfort that occurs spontaneously or under the influence of stimuli. It is observed in neuropathies, polyneuropathies, fibromyalgia, radicular syndrome, transverse myelitis, and some other diseases. The cause of occurrence is established on the basis of complaints, medical history, data from electrophysiological, imaging and laboratory methods. Treatment - NSAIDs, antibacterial agents, neurometabolites, physiotherapy. Some patients require surgery.
Dysesthesias are a variety of pathological sensations that are provoked by an inappropriate stimulus or appear without external influences. They include pain, itching, “tingling with pins”, “electric shock”, etc. Unlike paresthesia, they are perceived as unpleasant, causing significant discomfort. Considered in the framework of neuropathic pain. They are provoked by damage to peripheral nerves, less often by pathologies of the central nervous system.
Why does dysesthesia occur?
Polyneuropathies
The most common cause of dysesthesia in this group of diseases is diabetic neuropathy, which is diagnosed in 10% of the total number of patients and in half of patients with frequent hyperglycemia. The feet are mostly affected. Characterized by complaints of tingling, numbness, burning, muscle weakness. Possible allodynia. The symptoms are worse at night.
Alcoholic polyneuropathy usually manifests with paresthesias. Subsequently, dysesthesia, hypesthesia, allodynia join. Numbness progresses, due to which it seems to patients as if socks and gloves were put on the limbs, preventing the perception of sensory signals. Sensory and motor disorders gradually spread from the periphery to the center. Other polyneuropathies that can cause dysesthesia include:
- polyneuropathy of pregnant women;
- damage to the nerve trunks after radiation therapy;
- hereditary, autoimmune, metabolic and infectious-toxic polyneuropathies.
Neuropathy
Dysesthesia in the orbit and periorbital region occurs with Charlin's syndrome, a condition that develops against the background of neuralgia of the nasociliary nerve. The disease is manifested by bouts of pain, which, as a rule, are provoked by irritation of the lateral surface of the nose, lasting up to 1 hour. During the period of paroxysm, blepharospasm, photophobia, lacrimation, discharge from the nose, burning in the upper inner corner of the orbit are noted.
Another common neuropathy associated with dysesthesia is carpal tunnel syndrome. Numbness, pain and paresthesia are observed in 1-4 fingers of the hand, they decrease with movements, rubbing, waving the arms. Over time, accurate finger movements become difficult. In addition, dysesthesia is detected with the following neuropathies:
- Upper limb: radial, ulnar and median nerve.
- Proximal parts of the lower limb: sciatic, femoral, external cutaneous nerve of the thigh.
- Distal lower limb: tibia, fibula.
fibromyalgia
Patients complain of constant pain throughout the body, complemented by dysesthesias, numbness and "goosebumps". Fatigue is noted, which reaches a maximum in the morning, decreases during the day and increases again in the evening. Pain is aggravated by fatigue, physical exertion, prolonged immobility. Sleep disturbances appear. Half of patients with fibromyalgia are diagnosed with concomitant mental disorders.
Dysesthesia
radicular syndrome
The development of radicular syndrome is accompanied by muscle twitches, sensitivity disorders. Dysesthesias are sensations of heat or cold. The pains are burning, baking, shooting. Localization of sensory and motor disorders is determined by the level of the lesion. When the roots are involved at the level of the upper cervical region, the head suffers, while the lower one affects the neck and shoulder girdle.
With a lesion in the thoracic region, symptoms occur in the chest and abdomen, in the lumbar and sacral - in the area of \u200b\u200bthe lower back and lower extremities. The cause of the pathology is:
- Compression: osteochondrosis, intervertebral hernia, spondylosis, spondylarthrosis.
- Injuries: fractures and subluxations of the vertebrae, traumatic spondylolisthesis.
- Inflammation: tuberculosis, syphilis, osteomyelitis, spinal meningitis.
- Neoplasms: neoplasia of the spinal cord, tumors of the vertebrae, neurinomas of the spinal roots.
Acute myelitis
Dysesthesia against the background of acute transverse myelitis is observed in half of patients with multiple sclerosis. Less often, APM complicates such pathological conditions as:
- Autoimmune diseases: rheumatoid arthritis, systemic lupus erythematosus, Behçet's disease, sometimes optomyelitis, Sjögren's disease, sarcoidosis.
- Infectious diseases: mycoplasma infection, Lyme disease, tuberculosis, syphilis.
- Traumatic injuries: complicated spinal cord injury, post-traumatic spinal cord edema.
- Medical influences: radiation therapy, toxic damage during drug treatment, post-vaccination myelitis.
The first symptom is pain in the back or body along the line of the corresponding dermatome. Positive sensory disturbances include allodynia, dysesthesia, hyperesthesia, burning, and negative ones hypesthesia or anesthesia. Spread throughout the body below the level of the lesion. Tonic muscle spasms and other movement disorders are detected.
Guillain-Barré syndrome
This inflammatory autoimmune disease manifests with muscle weakness and sensory disturbances in the legs. After a few hours or days, the symptoms spread to the hands. Patients with GBS complain of numbness, paresthesia, dysesthesia. Paresis of varying severity develops. Sometimes there is damage to the cranial nerves. Respiratory failure may develop.
Thrombosis of the cavernous sinus
Dysesthesia and hypoesthesia in the area of the eyelid are one of the signs of thrombosis of the cavernous sinus. Complemented by strabismus, ophthalmoplegia or exophthalmos. Symptoms are preceded by headache and nausea. The face on the side of the lesion swells. There are disturbances of consciousness, focal neurological symptoms, less often - meningeal syndrome. TCS complicates the following pathological processes:
- Local infections: boils, abscesses, phlegmon of the orbit.
- ENT diseases: chronic rhinosinusitis, mastoiditis, otitis.
- Neuroinfections: encephalitis, bacterial meningitis.
- Non-infectious lesions of the central nervous system: craniocerebral trauma, primary and metastatic tumors.
- Collagenoses: Behçet's disease, Sjögren's syndrome, SLE.
- Thrombosis: thrombophlebitis of the ophthalmic or facial veins.
- Blood diseases: polycythemia, sickle cell anemia.
Other reasons
Temperature dysesthesia is observed with ciguatera, an infectious disease that occurs after eating certain types of fish and is accompanied by neurological disorders. Women with vestibulitis and vulvovestibulitis complain of discomfort in the area of the vulva and the entrance to the vagina. Sometimes dysesthesia develops with mental illness: hypochondria, generalized anxiety and panic disorder.
Diagnostics
Establishing the causes of dysesthesia is within the competence of neurologists. According to indications, patients are referred for consultations to an endocrinologist, rheumatologist, narcologist and other specialists. As part of the survey, they find out when the symptom first appeared, what other manifestations it was accompanied by, how the disease developed over time. The examination program includes the following diagnostic methods:
- Neurological examination. It provides for determining the zone of sensory disorders, their nature and severity, assessing muscle strength, and examining reflexes. The data obtained are used to make a preliminary diagnosis and draw up a list of additional procedures.
- Electrophysiological methods. Indicated for neuropathies and polyneuropathy, radicular syndrome and other neurological diseases. The severity of the pathological process, the level and severity of nerve damage are clarified using electroneurography and electromyography. In the future, studies are repeated to evaluate the effectiveness of therapeutic measures.
- X-ray techniques. X-ray and CT of the wrist joint help to determine the cause of compression of the median nerve in the carpal tunnel. With thrombosis of the venous sinuses on CT scan of the brain with contrast enhancement, a thrombus is visible in the region of the cavernous sinus. In the course of radiography and CT of the spine with radicular syndrome, signs of osteochondrosis, spondylolisthesis and other changes in solid structures are visualized.
- Magnetic resonance imaging. MRI of the brain is informative for venous thrombosis, multiple sclerosis, Charlin's syndrome. With fibromyalgia, it is performed to exclude tumors, intracranial hypertension and other pathological processes in the central nervous system. MRI of the spinal cord is indicative in assessing the state of soft tissue structures in patients with acute myelitis and radicular syndrome.
- Ophthalmic research. With Charlin's syndrome, ophthalmoscopy indicates the presence of hemorrhages, signs of damage to the uveal tract. During biomicroscopy, conjunctival hyperemia and degenerative changes in the cornea are determined. In patients with thrombotic lesions of the venous sinus, examination reveals hemianopsia, and ophthalmoscopy reveals dilation of the fundus veins, blurred boundaries, and protrusion of the optic nerve head.
- Laboratory tests. Recommended to determine the cause of polyneuropathy. Genetic and toxicological tests, antibody tests, biochemical blood tests may be prescribed. Suspicion of the infectious genesis of dysesthesia is an indication for ELISA, PCR, culture media.
Neurologist examination
Treatment
Conservative therapy
The treatment plan is made taking into account the causes of dysesthesia:
- Polyneuropathies. Carry out therapy of the underlying disease that provokes damage to peripheral nerves. In diabetes mellitus, the insulin therapy regimen is adjusted, in case of toxic effects, detoxification measures are performed, and in case of renal failure, hemodialysis is prescribed. As part of symptomatic therapy, antidepressants are used to reduce pain and normalize the psycho-emotional state, neurotrophic and vitamin preparations to improve metabolism and stimulate the restoration of nervous tissue.
- Neuropathy. If possible, the causes of the pathology are eliminated: traumatic and inflammatory edema, metabolic and endocrine disorders, etc. In the course of anti-inflammatory therapy, NSAIDs are used, and in severe cases, glucocorticoids. In Charlin's syndrome, antiepileptic drugs, local anesthetics, and sometimes ganglioblockers and calcium channel blockers are recommended. Physiotherapy for neuropathies includes electrophoresis, phonophoresis, galvanization, mud therapy. Showing exercise therapy, massage.
- Fibromyalgia. In the fight against acute pain syndrome, central analgesics are effective. In the treatment of chronic pain, sleep and mood disorders, antidepressants and anticonvulsants are used. Painful areas are irrigated with local anesthetics. Blockade of trigger zones is carried out. They prescribe acupuncture, hydrotherapy, physiotherapy exercises, work with a psychologist.
- Root Syndrome. Painkillers, neurometabolites, drugs to improve blood circulation, paravertebral blockades are shown. Antidepressants are used for chronic pain, and ganglionic blockers for neurotrophic disorders. In the acute period, ultraphonophoresis, UHF, reflexotherapy are effective. After the condition improves, exercise therapy, thermal procedures, massage, radon baths are carried out.
- transverse myelitis. Specific therapy has not been developed. In infectious diseases, antimicrobial agents are used. With demyelinating pathologies, hormonal pulse therapy, immunoglobulins, and cytostatics are required. With insufficient efficiency, extracorporeal blood purification by plasmapheresis is recommended.
- Thrombosis of the venous sinus. In the acute period, injection antithrombotic therapy is carried out, followed by a transition to oral anticoagulants. Broad-spectrum antibiotics are administered to fight the infection. The list of symptomatic drugs includes osmotic diuretics and anticonvulsants. In severe respiratory disorders, IVL is performed.
Surgery
Operational tactics is determined by the etiology of dysesthesia. The following interventions are possible:
- Cavernous thrombosis: removal of a thrombus, with increasing displacement of intracerebral structures with the risk of wedging of the trunk - decompression hemicraniotomy.
- Neuropathies: neurolysis, decompression or nerve plasty.
- Radicular syndrome: discectomy, microdiscectomy, nucleoplasty, stabilizing spinal surgery.
- Transverse myelitis: decompression interventions, debridement of a purulent focus using wide laminectomy.