What is Numbness?

Numbness refers to partial or complete loss of sensation in a body part.

Common Causes

• Nerve compression
• Stroke
• Multiple sclerosis
• Diabetes
• Disc prolapse
• Peripheral neuropathy 

Investigations

• MRI Brain
• MRI Spine
• Nerve Conduction Studies
• Blood tests 

Treatment Options

• Treating underlying cause
• Rehabilitation
• Physiotherapy 

Red Flags

• Sudden onset
• Weakness
• Speech difficulty
• Balance problems 

FAQs

Can numbness indicate stroke?

Yes.

Is numbness reversible?

Often, depending on the cause.

Should persistent numbness be evaluated?

Yes.

When to Consult

Early diagnosis can help prevent permanent nerve damage.

What is Vertigo?

Vertigo is the illusion of movement — specifically a spinning or rotational sensation either of the patient or their surroundings — in the absence of actual movement. It is distinct from dizziness (lightheadedness or pre-syncope) and must be differentiated clinically. Vertigo arises from asymmetric vestibular input reaching the brain.

Vertigo is broadly classified as peripheral (arising from the inner ear or vestibular nerve) or central (arising from the brain — brainstem or cerebellum). Central causes are potentially more serious and require careful clinical differentiation.

Common Causes

• Benign Paroxysmal Positional Vertigo (BPPV) — most common cause of true vertigo
• Vestibular neuritis (acute prolonged vertigo, often post-viral)
• Meniere's disease (recurrent vertigo with hearing loss and tinnitus)
• Migraine-associated vertigo / vestibular migraine
• Posterior fossa stroke or TIA
• Head injury

Bhattacharyya N, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1–S47. doi:10.1177/0194599816689667 — BPPV is the most common cause of vertigo; canalith repositioning (Epley maneuver) is effective first-line treatment.

HINTS Examination (to exclude stroke in acute vestibular syndrome)

In patients presenting with continuous acute vertigo, the HINTS (Head Impulse, Nystagmus, Test of Skew) examination is more sensitive than early MRI for detecting posterior fossa stroke:

• Head Impulse: normal (no corrective saccade) → CENTRAL (stroke)
• Nystagmus: direction-changing gaze-evoked nystagmus → CENTRAL
• Test of Skew: vertical skew deviation present → CENTRAL

Clinical Overview

Headache is one of the most prevalent neurological symptoms and can arise from a wide spectrum of causes ranging from benign tension-type headache to life-threatening intracranial pathology. Following head trauma, post-traumatic headache is defined as a headache developing within 7 days of injury and is a recognized diagnostic entity in the International Classification of Headache Disorders, 3rd edition (ICHD-3).

Headache Classification Committee of the International Headache Society (IHS). ICHD-3. Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202

McCrory P, et al. Consensus statement on concussion in sport — 5th Berlin conference 2016. Br J Sports Med. 2017;51(11):838–847. doi:10.1136/bjsports-2017-097699 — Headache is the most commonly reported post-concussion symptom.

Common Causes

• Post-traumatic headache (concussion)
• Intracranial hemorrhage
• Skull fracture
• Migraine
• Tension-type headache
• Cervicogenic headache (neck-related)
• Medication overuse headache

The Thunderclap Headache

A sudden-onset, severe headache reaching maximal intensity within seconds to minutes ("worst headache of life") is a neurological emergency until proven otherwise. This pattern raises immediate suspicion of subarachnoid hemorrhage (SAH) and requires urgent CT Head followed by lumbar puncture if CT is negative.

Investigations

• CT Head (first-line in acute severe headache)
• MRI Brain (for subacute and chronic presentations)
• Lumbar puncture (when SAH suspected and CT is normal)
• Neurological examination
• Blood tests