Persistent symmetrical tingling numbness at the ends of the fingers

Introduction The symmetry of the end of the finger, tingling, numbness and burning sensation is one of the manifestations of subacute combined degeneration of the spinal cord. Subacute combined degeneration of the spinal cord is a degenerative disease of the nervous system caused by vitamin B12 deficiency. Its clinical manifestations include deep sensory loss, sensory ataxia and spastic paralysis with spinal cord and lateral cord lesions, often accompanied by peripheral nerve damage. And the peripheral sensation of the symptoms.

Cause

The disease is associated with vitamin B12 deficiency. Myelin is a structure that promotes nerve impulse conduction around the nerve, and vitamin B12 is an essential coenzyme for myelin and nucleoprotein formation. Vitamin B12 deficiency causes myelin synthesis disorder and causes neurological and psychotic lesions; and vitamin B12 is also involved in hemoglobin. Synthetic, so lack of can lead to anemia.

The ingested vitamin B12 must be combined with the internal factors secreted by the cells in the stomach to form a stable complex that will not be absorbed by the intestinal bacteria and absorbed at the distal end of the ileum. Obstacles in any part of vitamin B12 uptake, absorption, binding and transport, such as congenital defects of endogenous factor secretion, atrophic gastritis, postoperative gastrectomy, primary intestinal malabsorption, ileal resection, etc. Causes vitamin B12 deficiency, causing clinical symptoms.

an examination

Related inspection

Spinal MRI examination CT examination

1. Most of the onset of illness in middle age, there is no significant difference between men and women. Chronic or subacute onset, slowly progressing, most patients have pale stagnation, diarrhea, glossitis, etc. before the neurological symptoms, with a decrease in serum Vit.B12. The early symptoms are weakness of the lower limbs, awkward hand movements, unstable walking, sensation of cotton, gait and basement widening; followed by symmetry of the toes and fingers, numbness, numbness and burning sensation, etc. Vibration, positional dysfunction, distal end is obvious, Romberg sign (+); a few have gloves, socks feel less. Very few patients have typical spinal cord and lateral cord lesions, but serum Vit.B12 levels are normal (without subacute combined degeneration of Vit. B12 deficiency).

2. Incomplete paralysis of the lower extremities, increased muscle tone, hyperreflexia and pathological signs; if the peripheral neuropathy is heavier, the muscle tone is reduced and the tendon reflex is weakened, but the pathological signs are often positive. Some patients have a Lhermitte sign when they bend their neck (a sense of acupuncture from the lower extremities). Sphincter dysfunction can occur in the advanced stage.

3. Common psychiatric symptoms: irritability, depression, hallucinations, confusion and paranoia, cognitive decline, even dementia, a small number of patients with optic atrophy and central dark spots, suggesting that the white matter and optic nerve are widely involved, rarely affected Other brain nerves.

Differential diagnosis

Finger numbness: The sensory nerve of the finger is distributed by the nerve roots separated by the cervical spinal cord to the hands and fingers. When the nerve damage occurs in some parts, inflammation, tumor, pressure, etc. cause abnormalities, fingers appear. Numbness.

Pain in the lateral side of the forearm and finger-like electric shock: The nerve root type cervical spondylosis is severely paroxysmal severe pain, and the nerve root is distributed along the outer arm and the finger is electrically shocked.

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