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paresthesia; burning; tingling
A sensation of burning, pricking, vibrating, buzzing, crawling, tingling, or tickling. Transient paresthesis may be induced by resting an extremity on the sciatic, peroneal or ulnar nerve, commonly recognized as an extremity 'falling asleep'. Other paresthesias arise without an apparent stimulus.
Etiology:
1) entrapment of peripheral nerve
2) ectopic foci in the central or peripheral nervous system
3) perioral paresthesias
a) hyperkalemia
b) hyperventilation (also hands)
c) vertebrobasilar artery territory TIA
d) pharmaceutical agents
1] amprenavir
2] pamidronate
4) B-vitamin deficiency
- thiamine deficiency
- vitamin B12 deficiency
- folate deficiency
Clinical manifestations:
1) Tinel's sign
a) carpal tunnel syndrome
b) cubital tunnel syndrome
2) Phalen's sign: carpal tunnel syndrome
3) sensory abnormalities of nerve entrapment syndromes
4) sensory, motor & reflex changes of radiculopathies
5) sensory abnormalities of diabetic polyneuropathy
6) abnormalities associated with vitamin B12 deficiency
7) signs & symptoms multiple sclerosis
8) findings associated with Guillain-Barre syndrome
9) perioral paresthesias
Laboratory:
1) glycated hemoglobin & hemoglobin A1c
2) serum vitamin B12 & Schilling test
3) cerebrospinal fluid (CSF) analysis
a) rising protein level in Guillain-Barre syndrome
b) oligoclonal banding in multiple sclerosis
4) serum calcium, serum albumin
5) TSH, free T4
6) tests for restless legs syndrome
Special laboratory:
-> electromyography
Radiology:
-> magnetic resonance imaging (multiple sclerosis)
Differential diagnosis:
1) entrapment neuropathy
a) carpal tunnel syndrome
b) cubital tunnel syndrome
c) peroneal neuropathy
d) meralgia paresthetica
2) radiculopathy
a) cervical: C5, C6 or C7
b) lumbosacral: L5 or S1
c) usually due to degenerative disc disease
3) restless legs syndrome
4) diabetic polyneuropathy
5) vitamin B12 deficiency
6) multiple sclerosis
7) Guillain-Barre syndrome
8) pharmacologic agents
a) isoniazid; b) vincristine; c) diuretics; d) NSAIDs
9) hypocalcemia
10) hypothyroidism
11) carcinomatous neuropathy
12) leprosy
13) polycythemia vera
14) alcoholism
15) connective tissue disorder
a) rheumatoid arthritis
b) systemic lupus erythematosus
16) heavy metal poisoning
a) lead
b) arsenic
c) others
13) peripheral nerve tumors
14) rabies
15) focal sensory seizures
Management:
-> see specific etiology
Related
burn
combustion; burning
Specific
acroparesthesia
General
sign/symptom
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1016-18
- NINDS Paresthesia Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Paresthesia-Information-Page