Paresthesia

Template:Short description Template:Use dmy datesTemplate:Redirect Template:Redirect Template:Distinguish Template:Infobox medical condition (new) Paresthesia is a sensation of the skin that may feel like numbness (hypoesthesia), tingling, pricking, chilling, or burning.<ref name="Paresthesia NINDS">Template:Cite web</ref> It can be temporary or chronic and has many possible underlying causes.<ref name="Paresthesia NINDS" /> Paresthesia is usually painless and can occur anywhere on the body, but does most commonly in the arms and legs.<ref name="Paresthesia NINDS" />

The most familiar kind of paresthesia is the sensation known as pins and needles after having a limb "fall asleep" (obdormition). This is typically achieved by not moving the limb for a long period of time. Hitting the ulnar nerve (the "funny bone", actually a nerve) also induces paresthesias. A less common kind is formication, the sensation of insects crawling on or under the skin.

Causes

Transient

Paresthesias of the hands, feet, legs, and arms are common transient symptoms. The briefest electric shock type of paresthesia can be caused by an impact on the comparatively unprotected ulnar nerve near the elbow; this phenomenon is colloquially known as bumping one's "funny bone". Other common examples occur when sustained pressure has been applied over a nerve, inhibiting or stimulating its function. Removing the pressure typically results in gradual relief of these paresthesias.<ref name="Paresthesia NINDS" /> Most pressure-induced paraesthesia results from awkward posture, such as engaging in cross-legged sitting for prolonged periods of time.<ref>Template:Cite web</ref> Similar brief shocks can be experienced when any other nerve is injured (e.g. a pinched neck nerve may cause a brief shock-like paresthesia toward the scalp). Spinal column irregularities may injure the spinal cord briefly when the head or back is turned, flexed, or extended into brief uncommon positions (Lhermitte's sign).<ref>Template:Cite journal</ref>

The most common everyday cause is temporary restriction of nerve impulses to an area of nerves, commonly caused by leaning or resting on parts of the body such as the legs (often followed by a pins and needles tingling sensation). Reactive hyperaemia, which occurs when blood flow is restored after a period of ischemia, may be accompanied by paresthesia too, e.g. when patients with Raynaud's disease rewarm after a cold episode.<ref>Template:Cite book</ref> Other causes include conditions such as hyperventilation syndrome and panic attacks, in which paresthesias of the mouth, hands, and feet are common, transient symptoms.<ref name=":0">Template:Citation</ref> A cold sore outside the mouth (not a canker sore inside the mouth) can be preceded by tingling due to activity of the causative herpes simplex virus.<ref>Template:Citation</ref> The varicella zoster virus, which causes shingles, also notably may cause recurring pain and tingling in skin or tissue along the distribution path of that nerve (most commonly in the skin, along a dermatome pattern, but sometimes feeling like a headache, chest or abdominal pain, or pelvic pain).<ref>Template:Cite web</ref><ref>Template:Cite web</ref>

Paresthesias can also be a symptom of mercury poisoning.<ref>Template:Cite journal</ref> Seafood poisoning is also possible, e.g., ciguatera toxin is produced within dinoflagellate plankton, which when consumed by other sea animals and then by humans, can lead to perioral paresthesia and temperature-related dysesthesia.<ref>Template:Cite journal</ref>

Cases of paresthesia have also been reported at varying frequencies following anthrax,<ref>Template:Cite journal</ref> flu,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> HPV,<ref>Template:Cite journal</ref> and COVID-19<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> vaccine intake. Benzodiazepine withdrawal may also cause paresthesia, as the drug removal leaves the GABA receptors desensitized. Benzodiazepines (e.g., Xanax and Valium) can be prescribed to try to relax muscle spasms or suppress epileptic seizures.<ref>Template:Cite journal</ref>

Chronic

Chronic paresthesia (Berger's paresthesia,<ref name="ICD-10_1">[ICD-10: R20.2]</ref> Sinagesia,<ref>[ICD-10: R25.1]</ref> or meralgia paresthetica<ref>[ICD-10: G57.1]</ref>) indicates either a problem with the functioning of neurons, or poor circulation.Template:Citation needed In the elderly, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease), most often caused by atherosclerosis, the build-up of plaque within artery walls over decades, with eventual plaque ruptures, internal clots over the ruptures, and subsequent clot healing, but leaving behind narrowing or closure of the artery openings, locally and/or in downstream smaller branches.<ref>Template:Cite web</ref> Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency or other malnutrition, as well as metabolic disorders like diabetes, hypothyroidism,<ref>Template:Citation</ref> or hypoparathyroidism.

Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist, and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,Template:Citation needed bone disease, poor posture, unsafe heavy lifting practices, or physical trauma such as whiplash.<ref name=":0" />

Another cause of paresthesia may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury, such as from frostbite; infections such as Lyme disease; or may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies, such as in the case of chemotherapy-induced peripheral neuropathy.<ref>Template:Cite web</ref> Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack; or autoimmune diseases such as multiple sclerosis, complex regional pain syndrome, or lupus erythematosus.Template:Citation needed The use of fluoroquinolones can also cause paresthesia.<ref>Template:Cite web</ref> Brainstem stroke survivors<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> and those with traumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.

Acroparesthesia

Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis.<ref name=brschemi>Template:Cite book</ref> It can also be a sign of hypocalcemia.<ref>Template:Cite journal</ref>

Dentistry

Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment.<ref>Template:Cite journal</ref>

Potential causes include trauma introduced to the nerve sheath during administration of the injection, hemorrhage about the sheath, more side-effect-prone types of anesthetic being used, or administration of anesthetic contaminated with alcohol or sterilizing solutions.<ref name=dentalparaesthesia>Template:Cite journal</ref>

Drugs

• Anticonvulsant pharmaceutical drugs, such as topiramate, sultiame, or acetazolamide
• Antidepressant discontinuation syndrome
• Benzodiazepine withdrawal syndrome
• Beta alanine
• Dextromethorphan (recreational use)
• Intravenous administering of strong pharmaceutical drugs acting on the central nervous system (CNS), mainly opiates, opioids, or other narcotics, especially in non-medical use (drug abuse)
• Ketorolac
• Lidocaine poisoning
• Lomotil
• Nitrous oxide, long-term exposure<ref>Template:Cite web</ref>
• Ritonavir<ref>Template:Cite journal</ref>

Other

Other causes may include: Template:Colbegin

• Autonomous sensory meridian response ("ASMR")<ref>Template:Cite journal</ref>
• Carpal tunnel syndrome
• Cerebral amyloid angiopathy
• Chiari malformation
• Coeliac disease
• Complex regional pain syndrome
• Cubital tunnel syndrome
• Decompression sickness
• Dehydration
• Erythromelalgia
• Fabry disease
• Fibromyalgia
• Fluoroquinolone toxicity
• Guillain–Barré syndrome (GBS)
• Heavy metals
• Herpes zoster
• Hydroxy alpha sanshool, a component of Sichuan peppers
• Hyperglycemia (high blood sugar)
• Hyperkalemia
• Hyperventilation
• Hypocalcemia, and in turn:
  • Hypermagnesemia, a condition in which hypocalcemia itself is typically observed as a secondary symptom
• Hypoglycemia (low blood sugar)
• Hypothyroidism
• Immunodeficiency, such as chronic inflammatory demyelinating polyneuropathy (CIDP)
• Lupus erythematosus
• Lyme disease
• Magnesium deficiency, often as a result of long-term proton-pump inhibitor use
• Menopause
• Mercury poisoning
• Migraines
• Multiple sclerosis
• Nerve compression syndrome
• Obdormition
• Oxygen toxicity, especially breathing oxygen under pressure, such as in scuba diving
• Pyrethrum or pyrethroid pesticides<ref>Vijverberg, H.P., van den Bercken, J. Crit. Rev. Toxicol. (1990) Neurotoxicological effects and the mode of action of pyrethroid insecticides.</ref>
• Post-polio syndrome
• Rabies
• Radiation poisoning
• Sarcoidosis
• Sciatica<ref>Template:Cite web</ref>
• Scorpion stings
• Spinal disc herniation or injury
• Spinal stenosis
• Stinging nettles
• Syringomyelia
• Transverse myelitis
• Variant Creutzfeldt–Jakob disease (AKA "mad cow disease")
• Vitamin B₅ deficiency
• Vitamin B₆ excess
• Vitamin B₁₂ deficiency

Diagnostics

A nerve conduction study usually provides useful information for making a diagnosis. An MRI or a CT scan is sometimes used to rule out certain causes stemming from central nervous system issues.<ref>Template:Cite journal</ref>

Treatment

Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or tiagabine, or antiviral medication, depending on the underlying cause.Template:Medical citation needed

In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as lidocaine or prilocaine. Ketamine has also been successfully used, but is generally not approved by insurance. Careful consideration must be taken to apply only the necessary amount, as excess can contribute to these conditions. Otherwise, these products generally offer extremely effective, but short-lasting relief from these conditions.

Paresthesia caused by stroke may receive some temporary benefit from high doses of baclofen multiple times a day.Template:Citation needed HIV patients who self-medicate with cannabis report that it reduces their symptoms.<ref>Template:Cite journal</ref>

Paresthesia caused by shingles is treated with appropriate antiviral medication.<ref>Template:Cite journal</ref>

Etymology

The word paresthesia (Template:IPAc-en; British English paraesthesia; plural paraesthesiae Template:IPAc-en or paraesthesias) comes from the Greek para ("beside", i.e., 'abnormal') and aisthesia ("sensation").<ref name="origin">Template:Cite web</ref>

Bibliography

• Template:Cite journal

External links

• Template:NINDS