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ULY CLINIC

15 Septemba 2025, 12:44:35

Paresthesia

Paresthesia refers to abnormal sensations — commonly described as numbness, tingling, or “pins and needles” — felt along peripheral nerve pathways. These sensations are usually not painful, but unpleasant or painful ones are termed dysesthesias. Paresthesia may be transient or persistent, and may arise from irritation or damage to the sensory pathway, including the parietal lobe, thalamus, spinothalamic tract, spinal cord, or peripheral nerves. It is a frequent manifestation of neurologic, vascular, metabolic, or toxic disorders.

History and Physical Examination

History

Establish onset, duration, and progression of abnormal sensations.
Ask about distribution: unilateral vs. bilateral, distal vs. proximal, dermatomal or glove-and-stocking.
Inquire about associated symptoms: sensory loss, muscle weakness, paralysis, gait disturbance, vision or speech changes.
Review past medical history (neurologic, vascular, metabolic, autoimmune, infectious, traumatic).
Explore medication use, toxin exposure, alcohol intake, and recent procedures or injuries.

Physical Examination

Assess level of consciousness and cranial nerve function.
Test muscle strength, tone, and deep tendon reflexes in affected limbs.
Examine sensory modalities: light touch, pain, temperature, vibration, and position sense.
Inspect skin color, temperature, and trophic changes; palpate peripheral pulses.
Look for ataxia, autonomic signs (diaphoresis, orthostatic changes), or Lhermitte’s sign.

Medical causes of paresthesia

Condition	Clinical Features	Other Important Information
Acute arterial occlusion	Sudden paresthesia and coldness in limb; mottled skin, absent pulses, aching pain	Medical emergency; often saddle embolus
Arteriosclerosis obliterans	Paresthesia, intermittent claudication, diminished popliteal/pedal pulses, pallor	Chronic limb ischemia
Cervical or lumbar arthritis	Neck/shoulder/arm or leg paresthesia	Due to degenerative or rheumatoid changes
Brain tumor (parietal lobe)	Progressive contralateral paresthesia ± agnosia, agraphia, hemianopsia	Mass effect on sensory cortex
Buerger’s disease	Cold, cyanotic feet; tingling after rewarming; intermittent claudication	Associated with smoking
Diabetes mellitus (neuropathy)	Burning or numbness in hands/feet; loss of vibration sense	Common cause of distal symmetric neuropathy
Guillain-Barré syndrome	Distal paresthesia preceding ascending weakness, areflexia	Monitor for respiratory failure
Head trauma	Focal or diffuse paresthesia, often with sensory loss, headache, seizures	Depends on site/severity
Herniated disk	Dermatomal paresthesia ± severe pain, spasm, weakness	Lumbar or cervical roots involved
Herpes zoster	Early tingling/burning along dermatome, then vesicular rash	Postherpetic neuralgia possible
Hyperventilation syndrome	Transient tingling of hands, feet, perioral area; anxiety, carpopedal spasm	Usually self-limited
Migraine aura	Tingling in face/hands before headache; may accompany visual scotoma	Neurologic symptoms resolve
Multiple sclerosis	Recurrent or progressive paresthesia; weakness, spasticity, hyperreflexia	One of earliest MS signs
Peripheral nerve trauma	Localized paresthesia or dysesthesia after injury	May be permanent if severe
Peripheral neuropathy (various)	Progressive glove-and-stocking tingling, weakness, atrophy	Causes include alcohol, toxins, B12 deficiency
Rabies (prodrome)	Tingling/itch at bite site; fever, photophobia, salivation	Rapidly progressive encephalitis
Raynaud’s disease	Cold-induced finger blanching → cyanosis → redness with tingling	Chronic cases may ulcerate
Seizure aura (parietal)	Tingling lips/fingers/toes before tonic-clonic seizure	Sensory seizure
Spinal cord injury/tumor	Paresthesia at or below lesion; sensory ± motor loss	Tumors may cause spasticity, bladder issues
Stroke/TIA	Sudden contralateral tingling; may include hemiplegia, visual loss, aphasia	TIA usually <10 min
Systemic lupus erythematosus	Paresthesia with arthritis, photosensitive rash	Vasculitic neuropathy
Tabes dorsalis	Late paresthesia of legs; ataxia, Charcot joints, Argyll Robertson pupils	Neurosyphilis
Radiation therapy	Delayed paresthesia from peripheral nerve damage	Usually chronic

Other causes

Drugs: phenytoin, vincristine, vinblastine, procarbazine, isoniazid, nitrofurantoin, chloroquine, parenteral gold.
Radiation therapy: may cause delayed neuropathy.

Special considerations

Paresthesia often coexists with patchy sensory loss — advise patients to check bathwater temperature and protect limbs from injury.
Evaluate fall risk and skin integrity, especially in elderly or diabetic patients.

Patient counseling

Explain likely cause and treatment options (e.g., glucose control, vitamin replacement, physical therapy).
Encourage smoking cessation, moderation of alcohol, and adherence to prescribed medications.
Emphasize prompt reporting of new weakness, bladder/bowel changes, or persistent numbness.

Pediatric pointers

Children may not verbalize tingling; look for clumsiness or reluctance to use affected limb.
Hereditary polyneuropathies and Guillain-Barré syndrome are common pediatric causes.

References

Berkowitz, C. D. (2012). Berkowitz’s Pediatrics: A Primary Care Approach (4th ed.). American Academy of Pediatrics.
Buttaro, T. M., Tybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice (pp. 444–447). Mosby Elsevier.
Colyar, M. R. (2003). Well-Child Assessment for Primary Care Providers. F.A. Davis.
Lehne, R. A. (2010). Pharmacology for Nursing Care (7th ed.). Saunders Elsevier.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2010). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier.
Sarwark, J. F. (2010). Essentials of Musculoskeletal Care. American Academy of Orthopaedic Surgeons.
Sommers, M. S., & Brunner, L. S. (2012). Pocket Diseases. F.A. Davis.