| Paresthesia | |
|---|---|
| Other names | Paraesthesia, pins and needles |
| Pronunciation | |
| Specialty | Neurology |
Paresthesia is a sensation of the skin that may feel like numbness (hypoesthesia), tingling, pricking, chilling, or burning.[1] It can be temporary orchronic and has many possible underlying causes.[1] Paresthesia is usually painless and can occur anywhere on the body, but does most commonly in the arms and legs.[1]
The most familiar kind of paresthesia is the sensation known aspins 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 isformication, the sensation of insects crawling on or under the skin.
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 unprotectedulnar 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 anerve, inhibiting or stimulating its function. Removing the pressure typically results in gradual relief of these paresthesias.[1] Most pressure-induced paraesthesia results from awkward posture, such as engaging incross-legged sitting for prolonged periods of time.[2] 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).[3]
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 ofischemia, may be accompanied by paresthesia too, e.g. when patients withRaynaud's disease rewarm after a cold episode.[4] Other causes include conditions such ashyperventilation syndrome andpanic attacks, in which paresthesias of the mouth, hands, and feet are common, transient symptoms.[5] A cold sore outside the mouth (not acanker sore inside the mouth) can be preceded by tingling due to activity of the causativeherpes simplex virus.[6] Thevaricella zoster virus, which causesshingles, 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 adermatome pattern, but sometimes feeling like a headache, chest or abdominal pain, or pelvic pain).[7][8]
Paresthesias can also be a symptom ofmercury poisoning.[9]Seafood poisoning is also possible, e.g.,ciguatera toxin is produced withindinoflagellate plankton, which when consumed by other sea animals and then by humans, can lead to perioral paresthesia and temperature-relateddysesthesia.[10]
Cases of paresthesia have also been reported at varying frequencies followinganthrax,[11]flu,[12][13]HPV,[14] andCOVID-19[15][16]vaccine intake.Benzodiazepine withdrawal may also cause paresthesia, as the drug removal leaves theGABA receptors desensitized. Benzodiazepines (e.g.,Xanax andValium) can be prescribed to try to relaxmuscle spasms or suppressepileptic seizures.[17]
Chronic paresthesia (Berger's paresthesia,[18] Sinagesia,[19] ormeralgia paresthetica[20]) indicates either a problem with the functioning of neurons, or poorcirculation.[citation needed] In the elderly, paresthesia is often the result of poor circulation in the limbs (such as inperipheral vascular disease), most often caused byatherosclerosis, the build-up of plaque within artery walls over decades, with eventualplaque ruptures, internal clots over the ruptures, and subsequent clot healing, but leaving behindnarrowing or closure of the artery openings, locally and/or in downstream smaller branches.[21] 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 ofvitamin deficiency or other malnutrition, as well as metabolic disorders likediabetes,hypothyroidism,[22] orhypoparathyroidism.
Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such asrheumatoid arthritis,psoriatic arthritis, andcarpal 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,[citation needed]bone disease, poor posture, unsafe heavy lifting practices, or physical trauma such aswhiplash.[5]
Another cause of paresthesia may be direct damage to the nerves themselves, i.e.,neuropathy, which itself can stem from injury, such as fromfrostbite; infections such asLyme disease; or may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies, such as in the case ofchemotherapy-induced peripheral neuropathy.[23] Chronic paresthesia can sometimes be symptomatic of serious conditions, such as atransient ischemic attack; orautoimmune diseases such asmultiple sclerosis,complex regional pain syndrome, orlupus erythematosus.[citation needed] The use offluoroquinolones can also cause paresthesia.[24]Brainstem stroke survivors[25][26] and those withtraumatic brain injury (TBI) may experience paresthesia from damage to the central nervous system.
Acroparesthesia is severe pain in the extremities, and may be caused byFabry disease, a type ofsphingolipidosis.[27] It can also be a sign ofhypocalcemia.[28]
Dental paresthesia is loss of sensation caused by maxillary or mandibular anesthetic administration before dental treatment.[29]
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.[30]
Other causes may include:
A nerve conduction study usually provides useful information for making a diagnosis. AnMRI or aCT scan is sometimes used to rule out certain causes stemming from central nervous system issues.[36]
Medications offered can include theimmunosuppressantprednisone, intravenousgamma globulin (IVIG),anticonvulsants such asgabapentin ortiagabine, orantiviral medication, depending on the underlying cause.[medical citation needed]
In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such aslidocaine orprilocaine.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 ofbaclofen multiple times a day.[citation needed]HIV patients who self-medicate with cannabis report that it reduces their symptoms.[37]
Paresthesia caused byshingles is treated with appropriateantiviral medication.[38]
The wordparesthesia (/ˌpærɪsˈθiːziə,-ʒə/; British Englishparaesthesia; plural paraesthesiae/-zii/ or paraesthesias) comes from theGreekpara ("beside", i.e., 'abnormal') andaisthesia ("sensation").[39]
Prodromal symptoms including burning, itching, or tingling may precede the outbreak by several hours.
Organic mercury affects the dorsal root and trigeminal ganglia, causing paresthesia, often before causing widespread [central nervous system] dysfunction.
Symptoms of hypocalcemia usually occur when ionized levels fall to <2.5 mg/dL. Symptoms include paresthesias of the extremities and face, followed by muscle cramps, carpopedal spasm, stridor, tetany, and seizures.
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
Most people have experienced temporary paresthesia -- a feeling of "pins and needles" -- at some time in their lives when they have sat with legs crossed for too long, or fallen asleep with an arm crooked under their head. It happens when sustained pressure is placed on a nerve. The feeling quickly goes away once the pressure is relieved.
Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage. Paresthesia can be caused by disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), multiple sclerosis, transverse myelitis, and encephalitis. A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia. Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain. Diagnostic evaluation is based on determining the underlying condition causing the paresthetic sensations. An individual's medical history, physical examination, and laboratory tests are essential for the diagnosis. Physicians may order additional tests depending on the suspected cause of the paresthesia.
