Medically Fit For Exams
Medically Fit For Exams

Change in sensation history taking


Differential diagnoses



Brain/spinal tumour

Spinal cord injury

Cauda equina

Diabetic neuropathy

Arterial insufficiency

Nerve root compression

Nerve palsy


Carpal tunnel

Alcoholism (B12 deficiency)


Anxiety/panic attack


  • Wash hands and introduce self to patient
  • Check patient’s name and DOB
  • Ask if you can talk to patient before they see the doctor


History of presenting complaint

  • Ask what has brought the patient in today
  • Ask the patient to tell you more about the tingling/numbness
  • Site
    • Hands/fingers (carpal tunnel, Raynauds)
    • Saddle anaesthesia (cauda equina)
    • Feet, legs (diabetic neuropathy)
    • Face (anxiety)
    • Back
    • General
    • Dermatomal (shingles)
    • Symmetrical?
  • Onset/timing
    • How long for?
    • Sudden onset?
    • Injury/incident preceding onset?
    • Constant/intermittent?
    • Have you had it before?
  • Character
    • Shooting (neuropathic pain)
    • Cold/numbness of fingers/toes plus colour change = Raynaud’s
    • Tingling
    • Numbness
    • Pain
  • Radiation
  • Associated features
    • Loss of function/motor ability/weakness (stroke, MS)
    • Changes in vision/eye pain (MS, nerve palsies, brain lesion)
    • Balance (cerebellar dysfunction, MS)
    • Speech (stroke, MS)
    • Headaches
    • Blackouts
    • Incontinence (cauda equina, MS)
    • Fever, fatigue, malaise, loss of appetite
    • Anxiety
  • Exacerbating/relieving factors
    • Cold (Raynaud’s)
    • Heat (MS)
  • Severity
    • How is it affecting your daily living? Is it stopping you doing anything?
  • ICE
    • Is there anything specific that you are concerned about?
    • Is there anything in particular that you thought was causing the symptoms?
  • Summarise and check what they’ve told you
  • Systems review if relevant – ask if you can ask a few brief questions about their general health
    • Headache, faints, fits
    • Weight loss, fatigue
    • Cough
    • SOB
    • Chest pain
    • Nausea/vomiting
    • Abdominal pain
    • Change in bowel habit
    • Change in waterworks
    • Aches and pains


Past medical history

  • Ask if they have any current or past health problems
  • Ask if they have had any surgery
  • Ask about:
    • Diabetes
    • Stress


Drug history

  • Ask if they are taking any medication, and if it has changed recently
  • Ask if they take any over the counter medications
  • Ask if they take any supplements



  • Ask if they have any allergies
  • Ask what happens


Family history

  • Ask if any medical problems run in their family
  • Ask if any family members have had similar problems with sensation
  • Ask about diabetes


Social history

  • Alcohol history
    • CAGE screening if suspect alcoholism as the cause of neuropathy
      • Have you tried/considered cutting down?
      • Get annoyed when others comment on your drinking?
      • Guilty about how much you drink?
      • Early morning drinking?
  • Smoking and pack years
  • Recreational drugs
  • Occupation
    • Impact of paraesthesia on job
  • Who they live with
    • Impact of paraesthesia on home life



  • Ask if they have any questions or other concerns
  • Ask if they think you have missed anything
  • Summarise again if necessary/time
  • Thank the patient for talking to you


Causes of paraesthesia


Facial/limb tingling/numbness, paraparesis (partial paralysis of lower limb), Lhermitte’s sign (electric shock down body), optic neuritis, blurred vision, dizziness, vertigo, ataxia, incontinence, retention, sexual dysfunction


TACS (total anterior): all of: unilateral weakness and/or sensory deficit of face, arm + leg, homonymous hemianopia, higher cerebral deficit (dysphasia, visuospatial disorder)

PACS (partial anterior): two of: unilateral weakness and/or sensory deficit of face, arm + leg, homonymous hemianopia, higher cerebral deficit (dysphasia, visuospatial disorder)

POCS (posterior): one of: cerebellar syndrome(ataxia, dysarthria, reduced muscle coordination) OR brainstem syndrome (dizziness, vertigo, loss of consciousness, breathing difficulty, diplopia) OR loss of consciousness OR isolated homonymous hemianopia

LACS (lacunar): no higher cerebral dysfunction + one of: unilateral weakness and/or sensory deficit in >=2 of face, arms + legs OR pure sensory stroke OR contralateral hemiparesis

Diabetic neuropathy

Loss of sensation, neuropathic ‘tingling’ or ‘shooting’ pain, usually starting in peripheries eg toes, history of diabetes/symptoms suggestive of diabetes

Brain tumour

Focal neurological deficit, depending on location, signs of raised ICP

Cauda equina

Saddle anaesthesia, leg weakness, urinary and/or faecal incontinence, sexual dysfunction

Alcoholic neuropathy B12

Lower leg/foot/toes paraesthesia, weakness, starts distal and spreads proximal, symmetrical, ataxic gait, falls




Change in sensation history taking.docx
Microsoft Word document [19.1 KB]

Get social with us.

Print Print | Sitemap