Abstract
Object: The purpose of this retrospective study was to better understand the diagnostic accuracy for dangerous causes (DC) of patients with the chief complaint of numbness in the emergency room.
Materials and Methods: Between January 2009 and March 2011, 95,514 patients visited the emergency center at Aizawa Hospital. Electronic charts of approximately 7,500 patients were reviewed to select suitable patients who had DC of numbness.
Results: Fifty-seven patients (13.2%) were diagnosed as having DC in the 433 patients who complained of numbness at the first visit. There were two patients with cerebral hemorrhage, one with epidural hematoma due to dural arteriovenous fistula, three with brain stem hemorrhage, 26 with cerebral infarction, 14 with brain stem infarction, one with multiple sclerosis, three with cervical spondylosis, one with cervical disk herniation, one with spinal cord tumor, one with myelitis, one with spinal cord infarction, one with acute arterial occlusion of a lower limb, one with hyperkalemia, and one with Guillain-Barré syndrome. Based on distribution of numbness, the 433 patients were divided into three groups. Group A: numbness in the unilateral extremities, unilateral upper or lower extremity and face, or face (125 patients). Group B: numbness in the unilateral upper or lower extremity (181 patients). Group C: numbness in the bilateral upper and/or lower extremities (116 patients). Even If brain computed tomography had been examined at first in the emergency room, 37 patients (29.6% among 125 patients of group A) , 9 patients (5.0% among 181 patients of group B), and 4 patients (3.4% among 116 patients of group C) would not have been correctly diagnosed as having DC, respectively. Even if brain magnetic resonance imaging had been further examined, three patients (2.4%), two patients (1.1%), and 4 patients (3.4%) would still have not been diagnosed as having DC, respectively.
Conclusion: Brain hemorrhage and infarction are the most frequent DC for patients with numbness, especially in the unilateral extremities. However, even if brain computed tomography and diffusion-weighted magnetic resonance imaging of the brain have been performed, 1.1 to 3.4% of patients who complained of numbness would still have not been diagnosed in the emergency room.
