Sensory Issues: Are They Vascular or Neurological?

Perceptual issues

The skin surface sensation on the thigh and buttocks feels as if there is a layer in between, and there is no sensation upon touch.
Is this a vascular issue or a neurological problem? Thank you.
(I have already checked CBC, creatinine, urine, and ESR; only the creatinine level rose to 1.15, but it returned to 0.99 after one week.)

Niming, 30~39 year old female. Ask Date: 2019/08/07

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider meralgia paresthetica, which is a condition involving the lateral femoral cutaneous nerve.
This nerve extends from the lateral border of the psoas major muscle and enters the subcutaneous tissue about 3 to 5 centimeters below the inguinal ligament, distributing to the skin on the outer thigh down to the knee joint.
If there are abnormal sensations in this area, it may indicate an issue with this nerve.
It is commonly seen in males aged 20 to 50 and presents with symptoms such as numbness in the anterior-lateral thigh, tingling, burning sensations, coldness, reduced sweating, and a feeling of heaviness, with numbness being the most prevalent symptom.
These symptoms may worsen with prolonged standing and can improve with rest.
During a physical examination, there may be a decrease in pain and temperature sensation, while proprioception remains intact.
The primary causes include local tissue fibrosis, prolonged standing, leg extension while lying supine, visceral ptosis, or prolonged tightness from a hard belt, which can stimulate or compress the nerve.
Additionally, excessive smoking, heavy alcohol consumption, pregnancy, toxicity, infections, or conditions such as diabetes, atherosclerosis, tumors, and hernias can increase the likelihood of developing this condition.
It is recommended that you visit a neurology clinic for further examination and follow-up.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2019/08/07

More Info

The symptoms you are describing, particularly the sensation of numbness or a feeling of having a barrier between your skin and the outside world, can indeed be linked to either vascular or neurological issues. Given that you have already undergone tests such as a Complete Blood Count (CBC), creatinine levels, urinalysis, and Erythrocyte Sedimentation Rate (ESR), and the only abnormality was a transient elevation in creatinine, it is essential to consider the broader context of your symptoms.

Neurological Considerations
1. Peripheral Neuropathy: This condition occurs when the peripheral nerves are damaged, leading to sensations such as numbness, tingling, or a "pins and needles" feeling. Common causes include diabetes, vitamin deficiencies (especially B12), and exposure to toxins. If your symptoms are localized to your thighs and buttocks, it may suggest a specific nerve issue, possibly related to compression or irritation of the nerves in that area.

2. Multiple Sclerosis (MS): While this is a less common cause, MS can lead to sensory disturbances due to demyelination of nerves in the central nervous system. Symptoms can vary widely, and sensory changes can be one of the first signs.

3. Radiculopathy: This occurs when a nerve root in the spine is compressed or irritated, often due to a herniated disc or spinal stenosis. This can lead to numbness or altered sensations in the areas supplied by the affected nerve.

Vascular Considerations
1. Circulatory Issues: Vascular problems, such as peripheral artery disease (PAD), can lead to reduced blood flow to the extremities, which might cause numbness or a tingling sensation. However, this is usually accompanied by other symptoms, such as pain during exertion or coldness in the affected limbs.

2. Transient Ischemic Attacks (TIAs): These are temporary episodes of neurological dysfunction caused by a lack of blood flow to the brain. While TIAs typically present with more acute symptoms, they can sometimes lead to lingering sensory changes.

Recommendations
1. Further Neurological Evaluation: Given your symptoms, it would be prudent to consult a neurologist for a comprehensive evaluation. This may include imaging studies such as an MRI of the brain and spine, nerve conduction studies, or electromyography (EMG) to assess nerve function.

2. Vascular Assessment: If there is a concern about vascular issues, a vascular specialist may perform tests such as Doppler ultrasound to evaluate blood flow in the arteries of your legs.

3. Lifestyle Modifications: Regardless of the underlying cause, maintaining a healthy lifestyle can help manage symptoms. This includes regular exercise, a balanced diet rich in vitamins and minerals, and avoiding smoking and excessive alcohol consumption.

4. Monitoring and Follow-Up: Since your creatinine levels returned to normal, it may be beneficial to continue monitoring kidney function, especially if you have risk factors for kidney disease. Regular follow-ups with your healthcare provider can help track any changes in your symptoms.

In summary, your symptoms could stem from either neurological or vascular origins, and a thorough evaluation by specialists in these fields is essential for accurate diagnosis and appropriate management.

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