Paresthesia

Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being "asleep" (but not directly related to the phenomenon of sleep). Its manifestation may be transient or chronic.

Numbness, tingling and abnormal sensations potentially occur secondary to lesions anywhere in the nervous system. They may be accompanied by a decreased sensation that can be noticed by exposure to painful stimuli.

Chronic condition
Chronic paresthesia indicates a problem with the functioning of neurons. This malfunction, which is especially common in older individuals, is often the result of poor circulation in the limbs (such as in peripheral vascular disease), which may be caused by atherosclerosis — the build up of plaque on artery walls. 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 and malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism.

Irritation to the nerve can also come frhe surroom inflammation to tunding tissue. Joint conditions such as rheumatoid arthritis and carpal tunnel syndrome are common sources of paresthesia.

Another cause of paresthesia, however, may be direct damage to the nerves themselves, or neuropathy, which can stem from injury or infection such as Lyme disease, or which may be indicative of a current neurological disorder. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack, a brain tumor, motor neurone disease, or autoimmune disorders like multiple sclerosis or lupus erythematosus. A diagnostic evaluation by a doctor is necessary to rule these out.

Paresthesiae of the mouth, hands, and feet are common, transient symptoms of the related conditions of hyperventilation syndrome and panic attacks.

History and Symptoms

 * A complete physical exam and history is necessary
 * Anatomic distribution
 * Onset
 * Personal history
 * Negative symptoms (weakness, pain etc.)

Laboratory Findings

 * Labs include:
 * BUN/Creatinine
 * Calcium
 * CBC
 * Electrolytes
 * ESR
 * Hemoglobin A1C
 * Magnesium
 * Thiamine
 * TSH
 * Vitamin B12

Electrolyte and Biomarker Studies

 * Nerve conduction studies

Chest X Ray

 * Chest X ray is indicated for differential diagnosis.

Other Imaging Findings

 * Electromyography - aids in muscular atrophy differentiation

Differential Diagnosis of Causes of

 * Acute idiopathic polyneuritis
 * Alcoholic neuropathy
 * Alcoholism and alcohol withdrawal
 * Amyloidosis
 * Amyotrophic lateral sclerosis
 * Anticonvulsant drugs such as topiramate, sulthiame, and acetazolamide
 * Brain tumor
 * Carpal Tunnel Syndrome
 * Cerebrovascular insult
 * Charcot-Marie-Tooth Syndrome
 * Collagen vascular disease
 * Dehydration
 * Diabetes Mellitus
 * Diptheria
 * Encephalitis
 * Entrapment neuropathy
 * Fabry disease
 * Fibromyalgia
 * Guillain-Barre Syndrome (GBS)
 * Head trauma
 * Heavy metals
 * Hereditary motor neuropathies
 * Herpes Zoster
 * Hyperventilation
 * Hypothyroidism
 * Immune deficiency, such as Chronic inflammatory demyelinating polyneuropathy (CIDP)
 * Infections
 * Leprosy
 * Lidocaine poisoning
 * Lomotil
 * Lyme Disease
 * Migrane
 * Multiple sclerosis
 * Nerve compression
 * Obdormition
 * Paraproteinemias
 * Peroneal palsy
 * Polyarteritis Nodosa
 * Porphyria
 * Radiation poisoning
 * Seizures
 * Sjogren's Syndrome
 * Systemic sclerosis
 * Tarsal tunnel
 * Throacic outlet syndrome
 * Toxins
 * Trigeminal neuralgia
 * Tumor
 * Ulnar entrapment
 * Uremia
 * Vasculitis
 * Vitamin B12 deficiency
 * Withdrawal from certain SSRIs, such as Paroxetine

Treatment
Treatment should be decided by a neurologist. Medications offered can include prednisone, intravenous gamma globulin (IVIG) and anticonvulsants such as gabapentin or gabitril, amongst others.

In some cases, rocking the head from side to side will painlessly remove the "pins and needles" sensation in less than a minute. A tingly hand or arm is often the result of compression in the bundle of nerves in the neck. Loosening the neck muscles releases the pressure. Compressed nerves lower in the body govern the feet, and standing up and walking around will typically relieve the sensation.

An arm that has "fallen asleep" may also be "awoken" more quickly by clenching and unclenching the fist several times; the muscle movement increases blood flow and helps the limb return to normal.

In general;


 * Immobilization
 * Support vitamin deficiency
 * Treat infections or diseases that may be underlying

Acute Pharmacotherapies

 * NSAIDs, acetominophin, epidural steroids (if severe)
 * Painful peripheral neuropathies - treat with amitriptyline,desipramine, phenytoin, carbamezapine or topical capsaicin cram

Indications for Surgery

 * Surgical tumor removal
 * Release of trapped nerve or disc