Numbness, pain, or strange sensations in the distal extremities
Introduction
Introduction Perceptual peripheral neuropathy, mainly manifested by varying degrees of numbness, pain, or abnormal sensation at the distal end of the extremities. The numbness, pain, or abnormal sensation of the distal extremities is not associated with cancerous toxins, infections, metabolic disorders, and dystrophies, and may be associated with immune responses caused by autoimmunity or cancer.
Cause
Cause
May have cancerous neuromuscular disease. The disease is caused by the fact that the pathogenesis has not yet been fully elucidated, and its pathogenesis is not related to cancer toxins, infections, metabolic disorders and nutritional disorders, and may be related to the immune response caused by autoimmunity or cancer.
Examine
an examination
Related inspection
Limb and joint movement
Pathological manifestations and symptoms of cancerous neuromuscular disease:
First, peripheral neuropathy.
(1) Sensory peripheral neuropathy. Mostly subacute or late onset, mainly manifested by different degrees of numbness, pain or abnormal sensation at the distal end of the extremities. Gradually proceed and develop to the near end, with a shallow, deep sensory barrier in gloves or short socks. Often accompanied by subacute small and cortical degeneration. The cerebrospinal fluid is normal or has elevated protein.
(2) Sensory-motor peripheral neuropathy. This type is more common in patients with lung cancer. The onset is more urgent, mainly manifested as symmetrical muscle weakness, muscle atrophy and sputum reflex in the distal extremities. It can also be accompanied by a lighter limb-feeling sensory disorder. Cerebrospinal fluid is more normal.
Second, muscle lesions.
(1) Cancerous muscle weakness syndrome. Common in small cell undifferentiated lung cancer. Mainly manifested as limb muscle weakness. It can also involve muscles such as the lips and throat, pronunciation and expression movement. After active exercise, the muscle strength may increase temporarily. Most of them have no response to neostigmine. Electromyogram repeat electrical stimulation has no amplitude decrease, which is different from myasthenia gravis.
(2) Myasthenia gravis. More common in thymoma or thymoma. Symptoms are the same as myasthenia gravis.
Third, spinal cord lesions. Clinically, it can be characterized by progressive spinal muscular atrophy, amyotrophic lateral sclerosis, subacute necrotizing spinal cord disease or transverse myelitis. The disease progresses faster, and in the worst case, it can lead to death.
Fourth, encephalopathy.
(1) Subacute cerebellar cortical degeneration. Acute or subacute onset, mainly manifested as cerebellar ataxia, ocular nystagmus, and mental disorders.
(2) Chronic organic psychosis. It is mostly slow, manifested as mental retardation, memory impairment, depression or euphoria, and occasionally Korsakov syndrome. There may also be seizures, paralysis, aphasia and involuntary movements.
(3) Border encephalitis. In the pathological examination, there were encephalitis-like changes in the hippocampal gyrus, the banded gyrus, and the frontal sacral surface of the limbic system, but there was no "encephalitis"-like appearance in the clinic.
Diagnosis
Differential diagnosis
In differential diagnosis, cancerous peripheral neuropathy is differentiated from peripheral neuritis caused by various causes and peripheral neuropathy caused by anticancer drugs; muscle changes should be associated with myasthenia gravis, non-cancerous polymyositis and dermatomyositis. Identification; spinal cord lesions should be differentiated from motor neuron disease, acute transverse myelitis; and other encephalopathy.
Pathological manifestations and symptoms of cancerous neuromuscular disease:
First, peripheral neuropathy.
(1) Sensory peripheral neuropathy. Mostly subacute or late onset, mainly manifested by different degrees of numbness, pain or abnormal sensation at the distal end of the extremities. Gradually proceed and develop to the near end, with a shallow, deep sensory barrier in gloves or short socks. Often accompanied by subacute small and cortical degeneration. The cerebrospinal fluid is normal or has elevated protein.
(2) Sensory-motor peripheral neuropathy. This type is more common in patients with lung cancer. The onset is more urgent, mainly manifested as symmetrical muscle weakness, muscle atrophy and sputum reflex in the distal extremities. It can also be accompanied by a lighter limb-feeling sensory disorder. Cerebrospinal fluid is more normal.
Second, muscle lesions.
(1) Cancerous muscle weakness syndrome. Common in small cell undifferentiated lung cancer. Mainly manifested as limb muscle weakness. It can also involve muscles such as the lips and throat, pronunciation and expression movement. After active exercise, the muscle strength may increase temporarily. Most of them have no response to neostigmine. Electromyogram repeat electrical stimulation has no amplitude decrease, which is different from myasthenia gravis.
(2) Myasthenia gravis. More common in thymoma or thymoma. Symptoms are the same as myasthenia gravis.
Third, spinal cord lesions. Clinically, it can be characterized by progressive spinal muscular atrophy, amyotrophic lateral sclerosis, subacute necrotizing spinal cord disease or transverse myelitis. The disease progresses faster, and in the worst case, it can lead to death.
Fourth, encephalopathy.
(1) Subacute cerebellar cortical degeneration. Acute or subacute onset, mainly manifested as cerebellar ataxia, ocular nystagmus, and mental disorders.
(2) Chronic organic psychosis. It is mostly slow, manifested as mental retardation, memory impairment, depression or euphoria, and occasionally Korsakov syndrome. There may also be seizures, paralysis, aphasia and involuntary movements.
(3) Border encephalitis. In the pathological examination, there were encephalitis-like changes in the hippocampal gyrus, the banded gyrus, and the frontal sacral surface of the limbic system, but there was no "encephalitis"-like appearance in the clinic.
