The Hypoaesthesia It is a perceptual problem in which there is a sensorial distortion. Specifically, there is a partial or total reduction of skin sensitivity. A patient with hypoesthesia may have less sensitivity to pain, changes in temperature; Or to capture the tactile stimuli in an attenuated way.
This condition can occur due to injuries involving the nervous system, both central and peripheral (nerve damage). Often it is a symptom of diseases such as multiple sclerosis , Diabetes, Stroke , Or tumors.
Hypoesthesia has also been found in patients with depression , In soldiers during the war, or in very intense emotional states.
Hypoesthesia may also occur with administration of drugs or drugs that have anesthetic effects.
Is hypoesthesia the same as paraesthesia? Conceptual clarifications
It is important not to confuse hypoesthesia with Paresthesia . The latter refers to an abnormal sensation of tingling or numbness in some part of the body. It does not have to be unpleasant.
On the other hand, it is useful to clarify that hypoesthesia is different from Dysesthesia . This is an unpleasant sensation, which can be painful or uncomfortable. It manifests as tingling, burning, punctures, cramps... that annoy the patient.
As for the term hypoalgesia, this refers exclusively to a decrease in the ability to feel pain. Hypoesthesia encompasses hypoalgesia, and includes, in addition, the lack of sensitivity to temperature and skin contact in general.
While anesthesia, it would be an extreme hypoesthesia. That is, a total loss of sensitivity of a certain area of the body.
The opposite of hypoesthesia would be hyperesthesia, which consists of an increase in the sensitivity of the skin. You may feel more pain (hyperalgesia), temperature, or any other skin sensation.
symptom
In fact, hypoesthesia refers to a symptom in itself rather than an isolated condition. That is, it is a consequence of another disorder or injury. In addition, the level of sensory perception in the affected area varies according to the case.
There may be a slight difference in the sensitivity of the skin between the right and left side, although there are cases where there is complete insensitivity to pain.
In addition, hypoesthesia tends to affect the arms and legs first before the trunk. If it covers the trunk, there may be some kind of Demyelination Or injury in the spinal cord .
A person with hypoesthesia feels that some part of their body is"asleep". This means that there is a reduction in skin sensitivity. Thus, it can capture much less intense than normal temperature, pain or any sensory stimulus.
However, according to Hallett, Ston & Carson (2016), most patients are not aware of their hypoesthesia until the first neurological examination is performed.
They may notice earlier if they are accidentally burned when they do not feel the heat, or if they scratch their skin or bruises without realizing it at the moment. It is dangerous because it could appear some harmful or harmful stimulus and not to react in time to avoid it.
Naturally, when you reach very advanced ages, the skin is losing sensitivity. That is why it is not strange that the elderly get injured or do not protect themselves from cold or heat, which endangers their health.
In some cases, they may manifest that they do not feel an arm or a leg. Although this seems to be more because of the loss of the"idea of the limb"rather than a cutaneous alteration.
This is shown because patients with loss of sensory function can only move their arm or leg when they look at them. And they can not do it if they have their eyes closed.
On the other hand, after certain brain damage as it can occur after a stroke, hypoesthesia or hemihipoesthesia may appear. In the latter case, there is a reduction of sensitivity only in one half of your body. Patients may note that they feel"split in half."
The affected parts may be small areas, such as the face, or larger areas. Hypoesthesia usually occurs more intensely in the front of the trunk than in the back.
In contrast, in other cases patients may lose skin sensitivity throughout the body. Usually this type of hypoesthesia lasts very little and usually occurs during very stressful events. Although hemihipoesthesia is much more common.
Causes
The causes of hypoesthesia can be very varied, since this is a symptom of some neurological type of affection.
When symptoms appear irregularly in the body, they can be difficult to distinguish from normal conditions. Or, they can be derived from other conditions such as Peripheral neuropathies .
If hypoesthesia disappears by itself, it is probably due to normal or mild conditions. It stands out for the subsequent appearance of tingling in the area. Temporal hypoesthesia tends to appear after a continuous uncomfortable position that compresses some nerve.
This symptom may arise due to non-serious circumstances, but it can also be a sign of more dangerous conditions for health. If it happens suddenly and spreads over time, it is important to go to a health professional to know their origin.
It may appear only from a lack of blood flow in an extremity, or from a nerve injury. Some of the most common causes of hypoesthesia are:
- Damage to the nervous system by some type of trauma, stroke, tumors... that compromise sensory function.
- Interruption of the blood flow of certain arteries, causing lack of oxygen in the cells. As a result it leads to injuries in them. A disease related to this that causes hypoesthesia is the Raynaud's syndrome .
- Neuropathies: these are a condition of the peripheral nervous system , That is, some damage to the nerves.
- Compression or injury to the nerves. For example, as a hernia in the intervertebral disc (herniated disc). It is a wear of the discs that are between the vertebrae, producing pressure on the nerves. This could lead to hypoesthesia, but also pain in some areas of the body.
Another example is the pathologies of the sciatic nerve, which goes from the lumbar vertebrae to the knee.
On the other hand, any deviation from the column (such as scoliosis ) Can also cause compression of a nerve that causes hypoesthesia.
A final example would be carpal tunnel syndrome, where there is a numbness in the inside of the wrist by nervous pressure.
- Diseases such as fibromyalgia, epilepsy, diabetes, migraine or hypothyroidism also have as a symptom in some patients hypoesthesia.
- Demyelinating diseases, that is, those in which there is a progressive loss of myelin in the nervous system. One example is multiple sclerosis.
- Congenital syndromes such as Tolosa-Hunt Syndrome , or the Brown Sequard Syndrome.
- Certain drugs or drugs, for example, those that have sedative effects such as certain anxiolytics. Some treatments such as radiation therapy or chemotherapy, lead poisoning... As well as excessive consumption of alcohol or other drugs that produce relaxation.
- Herpes zoster: this is an infectious disease that damages the sensory nerve ganglia and can produce intense pain and hypoesthesia.
- Unbalanced diet leading to low levels of calcium, sodium, potassium or vitamin B12, may increase episodes of hypoaesthesia.
- Bite or sting of an insect or poisonous animal.
- Very intense emotional states: for example, during an episode of great stress it is possible that the pain or blows are attenuated. This has been observed in wartime soldiers.
- Depression: during a depressive episode, the patient may find himself immersed in great apathy. Thus, they do not enjoy things as they used to.
It has also been observed that it can less intensely capture the stimuli of its surroundings like the colors, sounds, and of course, tactile sensations (appearing hypoesthesia).
How to diagnose hypoesthesia?
There are currently difficulties in reliably diagnosing hypoesthesia. This happens because there are no specific criteria and because it is not as easy to evaluate as movements or strength.
In addition, it is very likely that the examiner during the test suggests the patient with the sensations, and inaccurate results can be obtained. That is, the patient may not be able to express verbally what he is feeling.
This way, if you are asked to say"yes"when you feel something or"no"when you do not feel it during the exam; It is possible for the patient to consider that"no"means feeling the stimulus a little less than before. This occurs because the perception of sensations can be very subjective.
However, the main evaluation is still touching the skin with a brush, sponge or gauze. The pathological response would be a reduction in perception and numbness. The examiner will define whether the skin reaction to the sensory stimulus is below the normal threshold.
In the ICD-10, a diagnostic manual of the World Health Organization (WHO), includes hypoesthesia. It appears in a section called"symptoms and signs involving the skin and subcutaneous tissue", specifically within"alterations of skin sensitivity".
Mainly the diagnosis should be focused on finding the disease that is causing hypoesthesia. It is advisable to perform a brain scanner to see if there are damaged areas, such as magnetic resonance (MRI) or an Computed tomography (CT) .
Depending on the symptomology, blood tests, X-rays, ultrasound of the blood vessels or Electromyography .
Treatment
The treatment of hypoesthesia is very variable, since it depends on the condition that causes this symptom. If the cause is not treated, hypoesthesia may not stop.
If it is less severe, it may disappear by itself over time, or be dependent on the position. As in carpal tunnel syndrome.
Physical therapy, electrical therapy and nutritional supervision are usually combined. In some cases surgery may be necessary to eliminate compression of a nerve that is causing hypoesthesia.
Electrical stimulation consists of an apparatus that produces electric currents. It attaches to adhesive patches that are placed on the patient's skin, resulting in motor or sensory responses.
Another option is the stimulation of the affected peripheral nerves through Biofeedback (Hallett, Stone & Carson, 2016).
In general, to strengthen muscles and gain sensitivity, it is ideal to combine treatment with physical therapy.
An adequate diet is recommended to control episodes of hypoaesthesia due to lack of nutrients. How to take food with vitamin B12 (beef or pork liver, beef, clams, mackerel, salmon, dairy and eggs). As well as reducing the consumption of coffee and alcohol.
It is also important to take care to avoid injury, burns, cuts, bumps, or falls.
References
- Baron, R. (2006). Mechanisms of disease: neuropathic pain-a clinical perspective. Nature clinical practice Neurology, 2 (2), 95-106.
- Neurological pain. Positive phenomena. (S.f.). Retrieved from http://www.neurowikia.es/content/ on January 21, 2017.
- Hallett, M., Stone, J., & Carson, A.J. (2016). Functional Neurologic Disorders (Vol. 139). Academic Press.hypoesthesia. (S.f.). Retrieved from http://medical-dictionary.thefreedictionary.com on January 21, 2017, from Medical dictionary.
- Hypoesthesia. (S.f.). Retrieved from https://en.wikipedia.org/wiki/ on January 21, 2017.
- Hypoesthesia. (S.f.). Retrieved from http://www.humanitas.net/wiki/ on January 21, 2017, from Humanitas.
- Hypoesthesia - Definition. Retrieved from http://health.ccm.net/ (December 2016).
- Pan American Health Organization. (nineteen ninety five). International Statistical Classification of Diseases and Related Health Problems (Vol. 1). Pan American Health Org.
- Fisherman, M. (June 20, 2016). Numbness: Diagnosis. Obtained from Onmeda: onmeda.es.