Differential Diagnosis for Hemisensory Loss with No Lesions on Brain or Spinal Cord
Single Most Likely Diagnosis
- Peripheral neuropathy: This is a common cause of hemisensory loss, particularly if the neuropathy affects the nerves on one side of the body. Conditions such as diabetic neuropathy, vitamin deficiencies, or autoimmune disorders can lead to peripheral neuropathy.
Other Likely Diagnoses
- Multiple sclerosis: Although brain and spinal cord lesions are often associated with multiple sclerosis, some patients may present with sensory symptoms without visible lesions on initial imaging. Repeat imaging or further testing may be necessary to confirm the diagnosis.
- Neuropathic pain syndromes: Conditions like complex regional pain syndrome (CRPS) can cause hemisensory loss, usually accompanied by pain and other symptoms such as temperature or color changes in the affected limb.
- Radiculopathy: Nerve root damage or irritation can cause sensory loss in a dermatomal pattern, which may be perceived as hemisensory loss if multiple nerve roots are involved on one side of the body.
Do Not Miss Diagnoses
- Spinal cord infarction or ischemia: Although initial imaging may not show lesions, spinal cord infarction or ischemia can cause sudden onset of sensory loss. This condition requires prompt diagnosis and treatment to prevent further damage.
- Cauda equina syndrome: This is a serious condition caused by compression or damage to the nerve roots in the lower spine, which can lead to sensory loss, among other symptoms. Early recognition and treatment are crucial to prevent long-term damage.
- Vitamin B12 deficiency: A deficiency in vitamin B12 can cause subacute combined degeneration of the spinal cord, leading to sensory loss. This condition is treatable with supplementation, making it essential not to miss.
Rare Diagnoses
- Sjögren's syndrome: This autoimmune disorder can cause peripheral neuropathy, leading to hemisensory loss, although it is a less common presentation.
- Sarcoidosis: Neurosarcoidosis can cause a variety of neurological symptoms, including sensory loss, due to inflammation and damage to nerves.
- Lyme disease: In rare cases, Lyme disease can cause neurological symptoms, including sensory loss, particularly if the disease progresses to its late stages.