What are the possible neurological causes of a band-like sensation?

Neurological Causes of Band-Like Sensation

A band-like sensation around the trunk or limbs is most commonly caused by spinal cord lesions in multiple sclerosis, transverse myelitis, or compressive myelopathy, representing a dermatomal sensory disturbance from demyelination or structural damage affecting the spinothalamic tracts.

Primary Demyelinating Disorders

Multiple Sclerosis

• MS is the most frequent cause of band-like sensations, presenting as a "squeezing" or "tight band" feeling around the chest, abdomen, or limbs due to partial spinal cord lesions 1, 2.
• These sensory symptoms occur in the majority of MS patients and are often present even in early disease without significant disability 1.
• The sensation represents a form of dysesthesia from demyelinating plaques affecting sensory pathways in the spinal cord 3, 1.
• Sensory complaints in MS frequently include paresthesias, burning sensations, and band-like tightness, with approximately 50% of patients describing brief episodes of neurological dysfunction 1.
• Pain and sensory symptoms are independent of disease duration, disability level, or disease course 2.

Balo's Concentric Sclerosis

• Band-like enhancement on MRI imaging is a characteristic "red flag" finding in Balo's concentric sclerosis, a rare variant of demyelinating disease 4.
• This represents an atypical presentation that should prompt consideration of diagnoses beyond typical MS 4.

Neuromyelitis Optica Spectrum Disorders (NMOSD)

• NMOSD can cause longitudinally extensive transverse myelitis affecting ≥3 vertebral segments, producing band-like sensory symptoms 4.
• Cloud-like enhancement patterns on MRI and involvement of the diencephalon help differentiate NMOSD from MS 4.

Spinal Cord Pathology

Transverse Myelitis

• Inflammatory lesions of the spinal cord produce dermatomal sensory levels manifesting as band-like sensations at the level of cord involvement 4.
• The sensation corresponds to the upper border of sensory loss and represents partial cord dysfunction 4.

Compressive Myelopathy

• Cervical spondylosis with cord compression can produce the "pancake sign" on MRI and cause band-like sensations from mechanical compression 4.
• Structural lesions including tumors, herniated discs, or spinal stenosis may present similarly 4.

Peripheral Nerve Disorders

Diabetic Neuropathy

• Diabetic peripheral neuropathy typically presents as distal symmetric polyneuropathy with "stocking-glove" distribution rather than true band-like sensations 4.
• However, truncal radiculopathy in diabetes can produce band-like pain around the chest or abdomen 4.

Lyme Disease Neuropathy

• Late neurologic Lyme disease can cause peripheral neuropathy with radicular pain and intermittent limb paresthesias 4.
• The process typically manifests as confluent mononeuritis multiplex rather than discrete band-like sensations 4.

Peripheral Neuropathy in MS

• Approximately 45% of MS patients may have concurrent peripheral neuropathy with sensory-motor abnormalities detected electrophysiologically 5.
• This represents a coexisting condition rather than the primary cause of band-like sensations 5.

Critical Diagnostic Considerations

Red Flags Requiring Urgent Evaluation

• New band-like sensation with progressive weakness, bowel/bladder dysfunction, or gait disturbance mandates urgent spinal cord imaging to exclude compressive myelopathy or acute transverse myelitis 4.
• Band-like enhancement on MRI should prompt consideration of atypical demyelinating disorders including Balo's disease or NMOSD 4.
• Leptomeningeal enhancement, trident sign, or extensive longitudinal cord lesions suggest neurosarcoidosis or NMOSD rather than typical MS 4.

Distinguishing Central from Peripheral Causes

• True band-like sensations at a specific dermatomal level indicate spinal cord pathology rather than peripheral nerve disease 4.
• Peripheral neuropathies produce length-dependent symptoms (distal to proximal) rather than dermatomal distributions 4, 5.
• Associated neurological signs including hyperreflexia, Babinski sign, or sensory level confirm central (spinal cord) localization 4.

Common Pitfalls to Avoid

• Dismissing band-like sensations as "anxiety" or "functional" when they represent genuine spinal cord pathology, particularly in early MS 1, 2.
• Failing to obtain spinal MRI when band-like sensation is accompanied by any motor, sensory, or autonomic dysfunction 4.
• Overlooking the high frequency of undertreated sensory symptoms in MS, with only one-third of patients receiving appropriate treatment 2.
• Misattributing all sensory symptoms in MS patients to demyelination when concurrent peripheral neuropathy may be present 5.