Feeling detached

Introduction Separation of feeling: refers to the disease and other reasons destroy the posterior cord of the back of the spinal cord, so that the deep feeling can not be transmitted upwards, the position of the limb is not felt, and it is unclear that it is flexion and extension. Because I lost my understanding of my body, I was awkward when I acted and walked and swayed. Visible sensory separation is very meaningful for the diagnosis of neurological diseases. The doctor judges where the disease is based on the distribution of various sensory disturbances. This is called location diagnosis. At present, the treatment of the disease is mainly based on psychological treatment, and at the same time assisting other treatment measures to control the primary disease.

Cause

Causes:

The posterior cord of the back of the spinal cord was destroyed, making the deep sense unable to conduct upward. Whether it is a deep sensation or a shallow sensation, it is transmitted to the spinal cord through the conduction of peripheral nerves, and is transmitted separately after entering the spinal cord. The urge to feel deep into the back of the spinal cord called the posterior cord, up to the lowest medulla of the brain stem, crossed to the opposite side, and then up to the hindbrain. There is a crossover phenomenon both in feeling and in motion, and when the shallow feeling enters the spinal cord, it immediately passes through the center of the spinal cord to the opposite side, and finally to the thalamus. That is to say, the sense of depth in the thalamus is merged into one, and together they go to the hemisphere. The transmission of the sense of touch is divided into two ways, all of which follow the deep feeling of ascending, and the other way goes with the pain.

Separate sensory impairment refers to the patient's inability to perceive the stimulus in the case of clear consciousness. The sensory missing area can be severely damaged (such as burns) without being aware of it. Loss of sensation includes analgesia, loss of touch, loss of temperature and deep sensory disturbance (such as skin temperature and loss of pain), while other sensations (such as skin touch) are still preserved, called isolated sensory disturbance. Only deep feelings are missing, while those with shallow feelings (pain, temperature, touch) are also known as schizophrenic dysfunction.

an examination

Related inspection

Painful temperature sense position sense vibratory sensation

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. Position sense:

1 The patient closes his eyes and passively examines 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 forearm and thumb to make the wrist flexion and flexion 2 to 3 times. Then he uses the opposite thumb or finger to touch the thumb on the side. Touched.

3 palm test: the patient closed his eyes, rubbing his hands together, and the two hands could interact with each other as normal.

5. Vibration: Place the 128HZ tuning fork on the protruding bone, ask for vibration, and make double-sided and up-and-down contrast.

6. Solid sense:

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 to the normal range.

2 Touch the object with your hand and let it say the name of the object.

Differential diagnosis

Differential diagnosis of hemipathic sensory disturbance (hemianesthesia):

(1) Brain stem damage

Lateral sensation of the pons and midbrain lesions, lateral sensation disorder, lateral sensation and lateral dysfunction, syringomyelia showed pain, decreased temperature perception and deep sense of normal, spinal cord hernia showed deep sensation and recognition of tactile dysfunction The pain and temperature are normal, and the severe ones feel all the obstacles. The sensory disorder is lighter on the face, and the lesion starts from the face when it recovers, and the upper boundary of the sensory disorder is sequentially moved down.

(two) thalamic damage

The lesions have deep or shallow sensations on the lateral and body parts, with deep sensation and tactile dysfunction, and mild pain and temperature sensation. When closing early and retreating, the hand and foot are moving involuntarily due to the obstacle of the position of the finger. Often accompanied by feeling over or feeling wrong. The characteristic sensory disorder is partial spontaneous pain, that is, thalamic pain, which is often exacerbated by paroxysmal severe pain or persistent tingling or persistent pain. It can be caused by various stimuli (such as friction, compression, cold, sound, etc.). ) and the pain is aggravated. Mainly seen in cerebrovascular disease.

(three) damage to the internal capsule

Pain, warmth, tactile sensation or loss in the contralateral face, buccal mucosa, tongue, trunk and upper and lower fat, and dyskinesia, visual field disorder, three partial signs (contralateral hemiplegia, partial sensory disturbance, ipsilateral same direction) Partial blindness). The upper limb positional dysfunction is prominent, the distal end of the upper and lower limbs is more prominent than the proximal end, and the painful temperature sensation is more severe than the deep sensory dysfunction. The sensory disturbance is lighter in the midline of the trunk or 23 cm from the median line.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.