deep sensory disturbance
Introduction
Introduction "Deep feeling" refers to the sense of position of the muscles and joints, movement, and vibration. If the nerve fibers or brain-sensing central lesions that transmit deep sensations are present, muscle and joint positional sensation, motor sensation, and vibration dysfunction are deep sensory disturbances.
Cause
Cause
A neuromuscular or brain-sensing central lesion that conducts deep sensations.
Psychological studies on the brain mechanisms of sensory disturbances have confirmed that damage to the posterior region of the central sulcus of the human cerebral cortex is associated with the development of sensory disturbances. Sensory disturbances can have a wide-ranging impact on various psychological processes of human beings, and can cause perceptual obstacles, which can lead to disturbances in motor feedback and lead to motor dysfunction. Clinically, both neuropathy and psychosis can have symptoms of sensory impairment, and the former is more common.
Various damages to the nervous system can cause sensory-induced disorders when it involves receptors, conduction pathways, and sensory centers. The most common influencing factors are the nervous system and surrounding tissue tumors, trauma, infection, poisoning, degeneration, neurotrophic disorders, and Cerebrovascular disease, etc.
Sensory induction disorders vary depending on the nature of the lesion. When the lesion causes damage to the nervous system, the sensation diminishes or disappears, and when the nerve system is stimulated, it may cause hyperesthesia, over-sensation, or feeling inversion. Sensory decline is caused by increased stimulation threshold (inhibition) and decreased reactivity; hypersensitivity is caused by increased reactivity or decreased sensory threshold, mainly pain and tactile sensitivity; hypersensory is caused by increased sensory threshold and prolonged reaction.
Examine
an examination
Related inspection
Painful sense of position
The patient is asked to close his eyes during the examination. The examiner touches one of his fingers or a toe and asks him to answer which one he is touching. If the answer is correct, the position is normal; if the answer is incorrect, it is a positional disorder. Or slightly up, down or left, move the patient's finger (toe) to the right, ask them to answer the direction of the activity, answer correctly to indicate that the motor sensation is normal; if the answer is incorrect, it is dyskinesia. The vibration test is to place the vibrating tuning fork on the protruding part of the bone. Ask the patient to answer the vibration feeling. If there is vibration, the vibration is normal. If there is no vibration, it is a vibration disorder.
1. Pain: Use a pin to evenly stimulate the skin, observe and ask about the degree of pain.
2. Temperature sensation: With a test tube containing 5 to 10 ° C and 40 ° C to 45 ° C, respectively, in a closed case, the patient's skin is contacted in turn, and the feeling of cold or heat is expressed. The contact time is 2 to 3 seconds.
3. Tactile: The patient closes his eyes and touches his skin with a brush or cotton swab to ask if he has sensed or touched it several times. This method is used to check the original touch. When checking the recognition, the patient closes his eyes, writes or draws a simple graphic on the examination site, and asks the patient to speak the specified text and graphics.
4. Positional sensation: 1 The patient closes his eyes and passively checks the patient's limbs, such as the fingers and toes. The patient can correctly tell the movement, direction and position of these parts. 2 Thumb test: the patient closes his eyes and stretches his eyes. Straight forearm and thumb, make it for 2 to 3 times of flexion and extension of the wrist joint, and then use the opposite thumb or finger to touch the thumb on the side. When normal, it is linear motion; 3 palm test: the patient closes the eye. With both hands in the palm of your hand, the two hands can interact with each other as normal.
5. Vibration: Use a 128HZ tuning fork to place on the protruding bone, ask for vibration, and make double-sided and up-and-down contrast.
6. Physical sensation: 1 The patient closes his eyes, which indicates whether the stimulation point is one point or two points, and points out the minimum distance between the two points of stimulation, which is in contrast with the normal range; 2 touch the object by hand and let it name the object.
Diagnosis
Differential diagnosis
First, the classification of feelings
1, special feelings: including smell, vision, hearing, taste, vestibular or balance.
2, the general feeling: including a shallow feeling: refers to the pain, temperature, touch from the skin mucosa; 2 deep feeling: refers to the movement, position and vibration from the muscles, muscles, periosteum and joints; 3 composite feeling (Cortical sensation): Including the body sensation, positioning sensation and two points to distinguish the party, the complex feeling must be checked when the deep and shallow feelings are normal.
3, visceral sensation: conduction for autonomic nerves, such as hunger, nausea, visceral colic.
Second, the clinical manifestations of sensory impairment
(a) inhibitory symptoms
When the path is damaged or the function is suppressed, there is a loss or loss of sensation. In the same part, all kinds of sensations are missing, and the complete sensation is lost. For example, in the same part, there is only some sensory disorder and other sensations are preserved, which is called separation. Feeling the obstacle.
1. Loss of feeling: It means that the patient cannot perceive the stimulus in the case of clear consciousness. According to the different types of feelings, it can be divided into pain loss, tactile loss, temperature loss and deep sensory loss. Those with missing sensations in the same area are called complete sensation loss. If some of the feelings are missing in the same part and others feel normal, it is called a dissociative sensory disorder. Generally, the feeling is normal. In the case of no visual participation, the sensation of the stimulating part, the shape of the object, the weight, and the like are not discernible, and the cortex is said to be missing.
2, feeling down: refers to the sensitivity of the feeling is reduced. It is a low level of susceptibility to agriculture, but the degree is less than the sensation, and the sensory response is weakened due to the increased threshold of nerve excitation. When there is spontaneous pain in a nerve distribution area, and the pain is reduced in the area of neuralgia, it is called painful pain or painful paralysis. In a sensory disorder, when a certain feeling remains good, it is called a dissociative sensory disorder. Such as deep sensation and recognizing tactile dysfunction, pain, warmth and original tactile sensation, suggesting damage after the sling.
(two) irritating symptoms
Feeling allergic, sensation, over-sensation, paresthesia, or pain when the path is stimulated or excitatory.
1, feeling allergic: feeling threshold is low, refers to a slight (external or pathological) stimulation of strong reactions. Feeling allergies is common in shallow sensations, especially in hyperalgesia. Hyperalgesia can be caused by temperature stimulation, in addition to tactile or painful stimuli.
2, feeling excessive: generally only for shallow feelings. Excessive feeling generally has: 1 long incubation period, that is, there is a long incubation period from stimulation to perception, this period can sometimes reach 5 ~ 30 seconds; 2 sensitivity is reduced, excitability is increased, that is, stimulation must reach a strong degree to feel The stimuli felt by 3; are explosive, presenting a kind of violent, unclear, indescribable feeling of discomfort; 4 stimulating a tendency to spread, a single point of stimulating patients can feel multiple stimuli and spread to the surrounding; 5 After the stimulation is stopped, the patient still has the feeling of stimulating existence within a certain period of time, that is, the "post-effect" occurs. It is generally a feeling of strong discomfort. Common in burning neuralgia, banded sore pain, vascular lesions of the thalamus.
3, feeling backwards: the feeling of error in the stimulus. For example, the pain stimuli are mistaken for tactile or other stimuli. Feeling inversion is rare in the clinic, and most of them are shallow.
4, feeling abnormal: in the absence of any external stimuli, patients often feel ant walking or discomfort in certain parts, such as numbness, cold and hot, damp, vibration, ant walking, swelling, Electric shock, belt sensation, etc.
5, the sense of alignment: refers to the stimulation of one limb, the opposite side of the relative position is also stimulated.
