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Numbness

Where the numbness is tells you how urgent it is

Two patterns of numbness are emergencies. Most are not. The free check works out which one you have, in about ten minutes.

  • Free · no card needed
  • NHS FAST stroke screening built in
  • Checks for cauda equina
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Numbness

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Numbness
Introduction

Understanding the Numbness

Numbness on its own is common. Most of the time it is harmless. A leg that has gone to sleep. A patch on the thigh. Fingers that go dead in the cold.

But two patterns matter a great deal. In both of them, treatment is measured in hours. The check screens for both before anything else.

Call 999 now - numbness down one whole side

Sudden numbness in the face, arm and leg on the same side is a stroke until proven otherwise.

  • The numbness came on suddenly, over seconds or minutes
  • It affects one whole side - face, arm and leg together
  • One side of your face has dropped, or your smile is uneven
  • You cannot hold both arms up evenly
  • Your speech is slurred, or you cannot find your words
  • Your vision has changed suddenly
  • Note the exact time it started, and tell the ambulance crew. Clot-busting treatment has a window of about four and a half hours from the first symptom. Even if the numbness has already gone, you still need to be seen today. A mini-stroke is a warning that a full stroke may follow.

Source: NHS FAST stroke pathway · NICE NG128

CALL
999

Do it now. Every minute makes a difference.

Go to A&E now — numbness in the saddle area

Think of the part of you that would touch a saddle. That means the groin, the inner thighs, the buttocks and the area around the genitals. New numbness there is a surgical emergency. It is called cauda equina syndrome.

  • Numbness or a strange feeling in the groin, buttocks, inner thighs or genitals
  • You cannot tell when you need to pass urine, or you cannot start or stop the flow
  • You cannot feel yourself wiping after using the toilet
  • You have lost control of your bowels, or cannot feel a bowel movement coming
  • New weakness or numbness in both legs
  • Loss of normal sexual sensation
  • Go to A&E now. Use the words “saddle anaesthesia” and “possible cauda equina”. You need an emergency MRI scan of the lower spine within hours. Waiting can cause lasting loss of bladder, bowel and sexual function.

Source: RCGP / national cauda equina pathway — emergency MRI · NICE NG59 (low back pain and sciatica)

CALL
999

Do it now. Every minute makes a difference.

Numbness in one arm or leg, following a line

Some numbness runs in a strip down the arm or leg, often with pain. That usually means a nerve is trapped where it leaves the spine.

From the neck it causes numbness down the arm into particular fingers. From the lower back it causes numbness down the back of the leg into the foot — what most people call sciatica.

Most cases settle on their own. Get seen sooner if you are weak as well as numb. Get seen sooner if it is getting worse. Get seen sooner if you have had cancer in the past.

Source: NICE NG59 (low back pain and sciatica) · NICE CKS Neck pain — cervical radiculopathy

Two signs that point to multiple sclerosis

Lhermitte’s sign. You bend your chin towards your chest. That sets off an electric shock feeling down your spine, and sometimes into the arms and legs. It lasts a second or two.

Uhthoff’s phenomenon. Your symptoms get noticeably worse in a hot bath, in hot weather, or after exercise, and settle again once you cool down.

Neither is an emergency. But both suggest the problem is in the spinal cord or the brain, not in a single nerve. That points towards an MRI scan and a neurology opinion, rather than waiting to see.

Source: NICE NG220 (multiple sclerosis in adults)

Numbness in both hands with clumsiness and unsteadiness

Numb hands, dropping things, and fumbling with buttons and coins can add up to something. So can feeling unsteady on your feet. Together they can mean the spinal cord in your neck is being squeezed. This is called cervical myelopathy.

It comes on slowly, so it is easy to put down to age. It is worth getting seen. Treating it early protects movement and feeling that will not come back once they are lost.

Source: NICE NG128 · NICE CKS Neck pain — cervical myelopathy

Things that raise the stakes 

Some things in your background make new numbness more urgent. The check asks about all of these: 

  • A previous stroke or mini-stroke
  • An irregular heartbeat, particularly atrial fibrillation
  • Cancer now or in the past
  • A weakened immune system
  • Diabetes, high blood pressure or smoking
  • A recent fall, accident or injury to the back or neck 

Source: NICE CG109 (transient loss of consciousness) — 12-lead ECG as first-line

Symptoms we ask about

We ask about mood, memory, motor skills, and sensory changes to tailor your diagnosis and treatment.

common

Where exactly the numbness is 

Whether it came on suddenly or slowly 

Whether it is one side or both 

Whether there is weakness as well 

Any change in bladder or bowel control 

Any recent injury to the back or neck 

What happens next

Where nothing urgent is found, video appointments start at £399. These include sensory mapping and blood tests. Silver adds nerve tests and an MRI referral. In-person appointments start at £695.
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