Causes of Paresthesia
List of causes of Paresthesia
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Paresthesia)
that could possibly cause Paresthesia includes:
More causes:
see full list of causes for Tingling
Causes of Paresthesia (Diseases Database):
The follow list shows some of the possible medical causes of Paresthesia
that are listed by the Diseases Database:
Source: Diseases Database
Paresthesia Causes: Book Excerpts
Paresthesia as a complication of other conditions:
Other conditions that might have
Paresthesia as a complication may,
potentially, be an underlying cause of Paresthesia.
Our database lists the following as having
Paresthesia as a complication of that condition:
Paresthesia as a symptom:
Conditions listing Paresthesia
as a symptom may also be potential underlying causes of Paresthesia.
Our database lists the following as having
Paresthesia as a symptom of that condition:
Medications or substances causing Paresthesia:
The following drugs, medications, substances or toxins are some of the possible
causes of Paresthesia as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Dobutamine Hydrochloride
- Dobutrex
- Dobuject
- Oxiken
- Dextrothyroxine Sodium
- more drugs...»
See full list of 81
medications causing Paresthesia
Drug interactions causing Paresthesia:
When combined, certain drugs, medications, substances or toxins may react
causing Paresthesia as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Paresthesia
What causes Paresthesia?
Causes: Paresthesia:
Nerve damage, nerve entrapment, nerve compression, or damage to blood supply for a nerve.
Medical news summaries relating to Paresthesia:
The following medical news items are relevant to causes of Paresthesia:
Related information on causes of Paresthesia:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Paresthesia may be found in:
Causes of Paresthesia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Paresthesia.
Paresthesias:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Nerve compression or entrapment neuropathy
–Lumbosacral disc herniation with nerve root compression
–Posterior tibial nerve compression (tarsal tunnel syndrome)
–Peroneal nerve compression (foot drop)
–Cervical spine spondylosis/disc herniation with nerve root compression
–Median nerve compression (carpal tunnel syndrome, often seen in hypothyroidism and pregnancy)
–Ulnar nerve compression
–Long thoracic nerve compression (winged scapula)
-
Infections (e.g., HIV/AIDS, herpes zoster, Lyme disease)
-
Diabetic neuropathy (bilateral symptoms)
-
Alcoholic neuropathy
–Bilateral symptoms
–Due to thiamine deficiency (vitamin B1)
-
and/or direct toxic effect of alcohol
-
Vitamin B12 deficiency
-
Uremia
-
Vasculitis or collagen vascular disease
-
Tumor (including hematologic malignancy)
–Carcinomatous infiltration or direct compression
–Paraneoplastic syndrome (especially lung cancer) -
Toxins
–Industrial exposures (e.g., lead, mercury, pesticides)
–Medications (e.g., pyridoxine, isoniazid, vincristine, cisplatin, antiretrovirals, hydralazine)
-
Guillain-Barré syndrome (usually bilateral)
-
Hereditary motor or sensory neuropathies
-
Amyloidosis
-
Porphyria
-
Paraproteinemias (e.g., multiple myeloma)
-
Amyotrophic lateral sclerosis
-
Alcohol withdrawal (sensation of “crawling bugs”)
-
Trigeminal neuralgia
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Paresthesias:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Peripheral neuropathies (with or without pain)
–Entrapment neuropathies
–Carpal tunnel
–Lateral femoral cutaneous syndrome
–Pressure palsy
–Charcot-Marie-Tooth disease
–Amyloid neuropathy
–Symmetric peripheral neuropathy
-
Central nervous system etiologies
–Stroke
–Brain tumor
–Head trauma
–Abscess
–Encephalitis
–Systemic lupus erythematosus (SLE)
–Multiple sclerosis
–Transverse myelitis
–Vitamin B12 deficiency
-
Metabolic
–Diabetes
–Hypothyroidism
–Alcoholism
–Amyloidosis
–Uremia
-
Hyperventilation causing respiratory alkalosis
-
Connective tissue disorders
–Rheumatoid arthritis
–SLE
–Sjögren syndrome
-
Toxins
–Chemotherapy
–Heavy metal poisoning (e.g., lead, arsenic, and other metals)
–Medications (e.g., HIV medications, metronidazole, vincristine)
-
Neoplastic
–Multiple myeloma
–Monoclonal gammopathy
-
Infectious
–HIV
–Lyme disease
–Syphilis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Analgesia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Anterior cord syndrome. With anterior cord syndrome, analgesia and thermanesthesia occur bilaterally below the level of the lesion, along with flaccid paralysis and hypoactive deep tendon reflexes.
❑ Central cord syndrome. Typically, analgesia and thermanesthesia occur bilaterally in several dermatomes, in many cases extending in a capelike fashion over the arms, back, and shoulders. Early weakness in the hands progresses to weakness and muscle spasms in the arms and shoulder girdle. Hyperactive deep tendon reflexes and spastic weakness of the legs may develop. However, if the lesion affects the lumbar spine, hypoactive deep tendon reflexes and flaccid weakness may persist in the legs.
With brain stem involvement, additional findings include facial analgesia and thermanesthesia, vertigo, nystagmus, atrophy of the tongue, and dysarthria. The patient may also have dysphagia, urine retention, anhidrosis, decreased intestinal motility, and hyperkeratosis.
❑ Spinal cord hemisection. Contralateral analgesia and thermanesthesia occur below the level of the lesion. In addition, loss of proprioception, spastic paralysis, and hyperactive deep tendon reflexes develop ipsilaterally. The patient may also experience urine retention with overflow incontinence.
Other causes
❑ Drugs. Analgesia may occur with use of a topical or local anesthetic, although numbness and tingling are more common.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Skin, clammy:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, a headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, a headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, a headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Paresthesia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Arterial occlusion (acute)
With acute arterial occlusion, sudden paresthesia and coldness may develop in one or both legs with a saddle embolus. Paresis, intermittent claudication, and aching pain at rest are also characteristic. The extremity becomes mottled with a line of temperature and color demarcation at the level of occlusion. Pulses are absent below the occlusion, and the capillary refill time is increased.
Arteriosclerosis obliterans
Arteriosclerosis obliterans produces paresthesia, intermittent claudication (most common symptom), diminished or absent popliteal and pedal pulses, pallor, paresis, and coldness in the affected leg.
Arthritis
Rheumatoid or osteoarthritic changes in the cervical spine may cause paresthesia in the neck, shoulders, and arms. The lumbar spine occasionally is affected, causing paresthesia in one or both legs and feet.
Brain tumor
Tumors affecting the sensory cortex in the parietal lobe may cause progressive contralateral paresthesia accompanied by agnosia, apraxia, agraphia, homonymous hemianopsia, and a loss of proprioception.
Buerger’s disease
With Buerger’s disease, a smoking-related inflammatory occlusive disorder, exposure to cold makes the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication, which is aggravated by exercise and relieved by rest, is also common. Other findings include weak peripheral pulses, migratory superficial thrombophlebitis and, later, ulceration, muscle atrophy, and gangrene.
Diabetes mellitus
Diabetic neuropathy can cause paresthesia with a burning sensation in the hands and legs. Other findings include insidious, permanent anosmia; fatigue; polyuria; polydipsia; weight loss; and polyphagia.
Guillain-Barré syndrome
With Guillain-Barré syndrome, transient paresthesia may precede muscle weakness, which usually begins in the legs and ascends to the arms and facial nerves. Weakness may progress to total paralysis. Other findings include dysarthria, dysphagia, nasal speech, orthostatic hypotension, bladder and bowel incontinence, diaphoresis, tachycardia and, possibly, signs of life-threatening respiratory muscle paralysis.
Head trauma
Unilateral or bilateral paresthesia may occur when head trauma causes a concussion or contusion; however, sensory loss is more common. Other findings include variable paresis or paralysis, a decreased LOC, a headache, blurred or double vision, nausea and vomiting, dizziness, and seizures.
Herniated disk
Herniation of a lumbar or cervical disk may cause an acute or a gradual onset of paresthesia along the distribution pathways of affected spinal nerves. Other neuromuscular effects include severe pain, muscle spasms, and weakness that may progress to atrophy unless herniation is relieved.
Herpes zoster
An early symptom of herpes zoster, paresthesia occurs in the dermatome supplied by the affected spinal nerve. Within several days, this dermatome is marked by a pruritic, erythematous, vesicular rash associated with sharp, shooting, or burning pain.
Hyperventilation syndrome
Usually triggered by acute anxiety, hyperventilation syndrome may produce transient paresthesia in the hands, feet, and perioral area, accompanied by agitation, vertigo, syncope, pallor, muscle twitching and weakness, carpopedal spasm, and cardiac arrhythmias.
Migraine headache
Paresthesia in the hands, face, and perioral area may herald an impending migraine headache. Other prodromal symptoms include scotomas, hemiparesis, confusion, dizziness, and photophobia. These effects may persist during the characteristic throbbing headache and continue after it subsides.
Multiple sclerosis (MS)
With MS, demyelination of the sensory cortex or spinothalamic tract may produce paresthesia — typically one of the earliest symptoms. Like other effects of MS, paresthesia commonly waxes and wanes until the later stages, when it may become permanent. Associated findings include muscle weakness, spasticity, and hyperreflexia.
Peripheral nerve trauma
Injury to a major peripheral nerve can cause paresthesia — commonly dysesthesia — in the area supplied by that nerve. Paresthesia begins shortly after trauma and may be permanent. Other findings are flaccid paralysis or paresis, hyporeflexia, and variable sensory loss.
Peripheral neuropathy
Peripheral neuropathy can cause progressive paresthesia in all extremities. The patient also commonly displays muscle weakness, which may lead to flaccid paralysis and atrophy; a loss of vibration sensation; diminished or absent DTRs; neuralgia; and cutaneous changes, such as glossy, red skin and anhidrosis.
Rabies
Paresthesia, coldness, and itching at the site of an animal bite herald the prodromal stage of rabies. Other prodromal signs and symptoms are a fever, a headache, photophobia, hyperesthesia, tachycardia, shallow respirations, and excessive salivation, lacrimation, and perspiration.
Raynaud’s disease
Exposure to cold or stress makes the fingers turn pale, cold, and cyanotic; with rewarming, they become red and paresthetic. Ulceration may occur in chronic cases.
Seizure disorders
Seizures originating in the parietal lobe usually cause paresthesia of the lips, fingers, and toes. The paresthesia may act as auras that precede tonic-clonic seizures.
Spinal cord injury
Paresthesia may occur in partial spinal cord transection, after spinal shock resolves. It may be unilateral or bilateral, occurring at or below the level of the lesion. Associated sensory and motor loss is variable. (See Understanding spinal cord syndromes, page 472.) Spinal cord disorders may be associated with paresthesia on head flexion (Lhermitte’s sign).
Spinal cord tumors
Paresthesia, paresis, pain, and sensory loss along nerve pathways served by the affected cord segment result from such tumors. Eventually, paresis may cause spastic paralysis with hyperactive DTRs (unless the tumor is in the cauda equina, which produces hyporeflexia) and, possibly, bladder and bowel incontinence.
Stroke
Although contralateral paresthesia may occur with stroke, sensory loss is more common. Associated features vary with the artery affected and may include contralateral hemiplegia, a decreased LOC, and homonymous hemianopsia.
Systemic lupus erythematosus (SLE)
SLE may cause paresthesia, but its primary signs and symptoms include nondeforming arthritis (usually of the hands, feet, and large joints), photosensitivity, and a “butterfly rash” that appears across the nose and cheeks.
Tabes dorsalis
With tabes dorsalis, paresthesia — especially of the legs — is a common, but late, symptom. Other findings include ataxia, loss of proprioception and pain and temperature sensation, absent DTRs, Charcot’s joints, Argyll Robertson pupils, incontinence, and impotence.
Transient ischemic attack (TIA)
Paresthesia typically occurs abruptly with a TIA and is limited to one arm or another isolated part of the body. It usually lasts about 10 minutes and is accompanied by paralysis or paresis. Associated findings include a decreased LOC, dizziness, unilateral vision loss, nystagmus, aphasia, dysarthria, tinnitus, facial weakness, dysphagia, and an ataxic gait.
Other causes
Drugs
Phenytoin, chemotherapeutic agents (such as vincristine, vinblastine, and procarbazine), d-penicillamine, isoniazid, nitrofurantoin, chloroquine, and parenteral gold therapy may produce transient paresthesia that disappears when the drug is discontinued.
Radiation therapy
Long-term radiation therapy may eventually cause peripheral nerve damage, resulting in paresthesia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Analgesia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anterior cord syndrome
In anterior cord syndrome, analgesia and thermoanesthesia occur bilaterally below the level of the lesion along with flaccid paralysis and hypoactive DTRs.
Central cord syndrome
In central cord syndrome, analgesia and thermoanesthesia typically occur bilaterally in several dermatomes and may extend in a capelike fashion over the arms, back, and shoulders. Early weakness in the hands progresses to weakness and muscle spasms in the arms and shoulder girdle. Hyperactive DTRs and spastic weakness of the legs may develop. However, if the lesion affects the lumbar spine, hypoactive DTRs and flaccid weakness may persist in the legs.
With brain stem involvement, additional findings include facial analgesia and thermoanesthesia, vertigo, nystagmus, atrophy of the tongue, and dysarthria. The patient may also have anhidrosis, dysphagia, urine retention, decreased intestinal motility, and hyperkeratosis.
Spinal cord hemisection
Contralateral analgesia and thermoanesthesia occur below the level of the lesion. In addition, loss of proprioception, spastic paralysis, and hyperactive deep tendon reflexes develop ipsilaterally. The patient may also experience urine retention with overflow incontinence.
Other causes
Drugs
Analgesia may occur with use of a topical or local anesthetic, although numbness and tingling are more common.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Skin, clammy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Paresthesia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Arterial occlusion (acute)
With this disorder, sudden paresthesia and coldness may develop in one or both legs with a saddle embolus. Paresis, intermittent claudication, and aching pain at rest are also characteristic. The extremity becomes mottled with a line of temperature and color demarcation at the level of occlusion. Pulses are absent below the occlusion, and capillary refill time is increased.
Arteriosclerosis obliterans
This disorder produces paresthesia, intermittent claudication (most common symptom), diminished or absent popliteal and pedal pulses, pallor, paresis, and coldness in the affected leg.
Arthritis
Rheumatoid or osteoarthritic changes in the cervical spine may cause paresthesia in the neck, shoulders, and arms. The lumbar spine occasionally is affected, causing paresthesia in one or both legs and feet.
Brain tumor
Tumors affecting the sensory cortex in the parietal lobe may cause progressive contralateral paresthesia accompanied by agnosia, apraxia, agraphia, homonymous hemianopsia, and loss of proprioception.
Buerger’s disease
With this smoking-related inflammatory occlusive disorder, exposure to cold makes the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication, which is aggravated by exercise and relieved by rest, is also common. Other findings include weak peripheral pulses, migratory superficial thrombophlebitis and, later, ulceration, muscle atrophy, and gangrene.
Diabetes mellitus
Diabetic neuropathy can cause paresthesia with a burning sensation in the hands and legs.Other findings include insidious, permanent anosmia, fatigue, polyuria, polydipsia, weight loss, and polyphagia.
Guillain-Barré syndrome
With this syndrome, transient paresthesia may precede muscle weakness, which usually begins in the legs and ascends to the arms and facial nerves. Weakness may progress to total paralysis. Other findings include dysarthria, dysphagia, nasal speech, orthostatic hypotension, bladder and bowel incontinence, diaphoresis, tachycardia and, possibly, signs of life-threatening respiratory muscle paralysis.
Head trauma
Unilateral or bilateral paresthesia may occur when head trauma causes a concussion or contusion; however, sensory loss is more common. Other findings include variable paresis or paralysis, decreased LOC, headache, blurred or double vision, nausea and vomiting, dizziness, and seizures.
Heavy metal or solvent poisoning
Exposure to industrial or household products containing lead, mercury, thallium, or organophosphates may cause paresthesia of acute or gradual onset. Mental status changes, tremors, weakness, seizures, and GI distress are also common.
Herniated disk
Herniation of a lumbar or cervical disk may cause acute or gradual onset of paresthesia along the distribution pathways of affected spinal nerves. Other neuromuscular effects include severe pain, muscle spasms, and weakness that may progress to atrophy unless herniation is relieved.
Herpes zoster
An early symptom of this disorder, paresthesia occurs in the dermatome supplied by the affected spinal nerve. Within several days, this dermatome is marked by a pruritic, erythematous, vesicular rash associated with sharp, shooting, or burning pain.
Hyperventilation syndrome
Usually triggered by acute anxiety, this syndrome may produce transient paresthesia in the hands, feet, and perioral area, accompanied by agitation, vertigo, syncope, pallor, muscle twitching and weakness, carpopedal spasm, and cardiac arrhythmias.
Hypocalcemia
Asymmetrical paresthesia usually occurs in the fingers, toes, and circumoral area early in this disorder. Other signs and symptoms are muscle weakness, twitching, or cramps; palpitations; hyperactive DTRs; carpopedal spasm; and positive Chvostek’s and Trousseau’s signs.
Migraine headache
Paresthesia in the hands, face, and perioral area may herald an impending migraine headache. Other prodromal symptoms include scotomas, hemiparesis, confusion, dizziness, and photophobia. These effects may persist during the characteristic throbbing headache and continue after it subsides.
Multiple sclerosis (MS)
With this disorder, demyelination of the sensory cortex or spinothalamic tract may produce paresthesia—typically one of the earliest symptoms. Like other effects of MS, paresthesia commonly waxes and wanes until the later stages, when it may become permanent. Associated findings include muscle weakness, spasticity, and hyperreflexia.
Peripheral nerve trauma
Injury to any major peripheral nerve can cause paresthesia—often dysesthesia—in the area supplied by that nerve. Paresthesia begins shortly after trauma and may be permanent. Other findings are flaccid paralysis or paresis, hyporeflexia, and variable sensory loss.
Peripheral neuropathy
This syndrome can cause progressive paresthesia in all extremities. The patient also commonly displays muscle weakness, which may lead to flaccid paralysis and atrophy; loss of vibration sensation; diminished or absent DTRs; neuralgia; and cutaneous changes, such as glossy, red skin and anhidrosis.
Rabies
Paresthesia, coldness, and itching at the site of an animal bite herald the prodromal stage of rabies. Other prodromal signs and symptoms are fever, headache, photophobia, hyperesthesia, tachycardia, shallow respirations, and excessive salivation, lacrimation, and perspiration.
Raynaud’s disease
Exposure to cold or stress makes the fingers turn pale, cold, and cyanotic; with rewarming, they become red and paresthetic. Ulceration may occur in chronic cases.
Seizure disorders
Seizures originating in the parietal lobe usually cause paresthesia of the lips, fingers, and toes. The paresthesia may act as auras that precede tonic-clonic seizures.
Spinal cord injury
Paresthesia may occur in partial spinal cord transection, after spinal shock resolves. It may be unilateral or bilateral, occurring at or below the level of the lesion. Associated sensory and motor loss is variable. (See Understanding spinal cord syndromes, page 599.) Spinal cord disorders may be associated with paresthesia on head flexion (Lhermitte’s sign).
Spinal cord tumors
Paresthesia, paresis, pain, and sensory loss along nerve pathways served by the affected cord segment result from such tumors. Eventually, paresis may cause spastic paralysis with hyperactive DTRs (unless the tumor is in the cauda equina, which produces hyporeflexia) and, possibly, bladder and bowel incontinence.
Stroke
Although contralateral paresthesia may occur with stroke, sensory loss is more common. Associated features vary with the artery affected and may include contralateral hemiplegia, decreased LOC, and homonymous hemianopsia.
Systemic lupus erythematosus
This disorder may cause paresthesia, but its primary signs and symptoms include nondeforming arthritis (usually of hands, feet, and large joints), photosensitivity, and a “butterfly rash” that appears across the nose and cheeks.
Tabes dorsalis
With this disorder, paresthesia—especially of the legs—is a common, but late, symptom. Other findings include ataxia, loss of proprioception and pain and temperature sensation, absent deep tendon reflexes, Charcot’s joints, Argyll Robertson pupils, incontinence, and impotence.
Thoracic outlet syndrome
Paresthesia occurs suddenly in this syndrome when the affected arm is raised and abducted. The arm also becomes pale and cool with diminished pulses. Unequal blood pressure between arms may be noted.
Transient ischemic attack (TIA)
Paresthesia typically occurs abruptly with a TIA and is limited to one arm or another isolated part of the body. It usually lasts about 10 minutes and is accompanied by paralysis or paresis. Associated findings include decreased LOC, dizziness, unilateral vision loss, nystagmus, aphasia, dysarthria, tinnitus, facial weakness, dysphagia, and ataxic gait.
Vitamin B deficiency
Chronic thiamine or vitamin B12 deficiency may cause paresthesia and weakness in the arms and legs. Burning leg pain, hypoactive DTRs, and variable sensory loss are common in thiamine deficiency; vitamin B12 deficiency also produces mental status changes and impaired vision.
Other causes
Drugs
Phenytoin, chemotherapeutic agents (such as vincristine, vinblastine, and procarbazine), d-penicillamine, isoniazid, nitrofurantoin, chloroquine, and parenteral gold therapy may produce transient paresthesia that disappears when the drug is discontinued.
Radiation therapy
Long-term radiation therapy eventually may cause peripheral nerve damage, resulting in paresthesia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Visual Disturbance:
Differential Overview
(Field Guide to Bedside Diagnosis)
Acute Loss/Scotoma
❑ Ophthalmic migraine
❑ Amaurosis fugax
❑ Retinal detachment
❑ Acute angle closure glaucoma
❑ Optic neuritis
❑ Papilledema
❑ Retinal artery occlusion
❑ Giant cell arteritis
❑ Trauma
❑ Toxic
❑ Occipital stroke
❑ Ischemic optic neuropathy
❑ Retinal hemorrhage
❑ Vitreous hemorrhage
❑ Central retinal vein occlusion
Gradual Loss
❑ Refractive error
❑ Intraocular hypertension
❑ Cataract
❑ Diabetic retinopathy
❑ Macular degeneration
❑ Cytomegalovirus retinitis
❑ Drugs
❑ Keratoconjunctivitis sicca
❑ Optic nerve compression
❑ Pituitary adenoma
❑ Choroidal melanoma
❑ Retinitis pigmentosa
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Analgesia:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Anterior cord syndrome
Analgesia and thermanesthesia occur bilaterally below the level of the lesion, along with flaccid paralysis and hypoactive DTRs.
Central cord syndrome
Analgesia and thermanesthesia occur bilaterally in several dermatomes, in many cases extending in a capelike fashion over the arms, back, and shoulders. Early weakness in the hands is evident and progresses to weakness and muscle spasms in the arms and shoulder girdle. Hyperactive DTRs and spastic weakness of the legs may develop. (If hypoactive, DTRs and flaccid weakness persist in the legs, a lesion in the lumbar spine may be suspected.)
With brain stem involvement, additional findings include facial analgesia and thermanesthesia, vertigo, nystagmus, atrophy of the tongue, dysarthria, dysphagia, urine retention, anhidrosis, decreased intestinal motility, and hyperkeratosis.
Spinal cord hemisection
Contralateral analgesia and thermanesthesia occur below the level of the lesion. In addition, loss of proprioception, spastic paralysis, and hyperactive DTRs develop ipsilaterally. Urine retention with overflow incontinence may be present.
Other causes
Drugs
Analgesia may occur with the use of a topical or local anesthetic, although numbness and tingling are more common.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Skin, clammy:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock
Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, hypotension, blurred vision, and loss of consciousness.
Hypoglycemia (acute)
Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.
Septic shock
The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Skin, clammy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Anxiety
An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Cardiac arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension. The pulse rate may be rapid, slow, or irregular. The patient may report palpitations, chest pain, diaphoresis, light-headedness, and weakness.
Cardiogenic shock
With cardiogenic shock, generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria. Associated signs and symptoms include anginal pain, dyspnea, jugular vein distention, ventricular gallop, and a weak, rapid pulse.
Heat exhaustion
In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute)
With acute hypoglycemia, generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock
With hypovolemic shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage of septic shock causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Paresthesia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Arterial occlusion (acute)
With acute arterial occlusion, sudden paresthesia and coldness may develop in one or both legs with a saddle embolus. Paresis, intermittent claudication, and aching pain at rest are also characteristic. The extremity becomes mottled with a line of temperature and color demarcation at the level of occlusion. Pulses are absent below the occlusion, and capillary refill time is increased.
Arteriosclerosis obliterans
Arteriosclerosis obliterans produces paresthesia, intermittent claudication (most common symptom), diminished or absent popliteal and pedal pulses, pallor, paresis, and coldness in the affected leg.
Arthritis
Rheumatoid or osteoarthritic changes in the cervical spine may cause paresthesia in the neck, shoulders, and arms. The lumbar spine occasionally is affected, causing paresthesia in one or both legs and feet.
Brain tumor
Tumors affecting the sensory cortex in the parietal lobe may cause progressive contralateral paresthesia accompanied by agnosia, apraxia, agraphia, homonymous hemianopsia, and loss of proprioception.
Buerger’s disease
With Buerger’s disease, exposure to cold makes the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication, which is aggravated by exercise and relieved by rest, is also common. Other findings include weak peripheral pulses, migratory superficial thrombophlebitis and, later, ulceration, muscle atrophy, and gangrene.
Diabetes mellitus
Diabetic neuropathy can cause paresthesia with a burning sensation in the hands and legs.Other findings include insidious, permanent anosmia; fatigue; polyuria; polydipsia; weight loss; and polyphagia.
Guillain-Barré syndrome
With Guillain-Barré syndrome, transient paresthesia may precede muscle weakness, which usually begins in the legs and ascends to the arms and facial nerves. Weakness may progress to total paralysis. Other findings include dysarthria, dysphagia, nasal speech, orthostatic hypotension, bladder and bowel incontinence, diaphoresis, tachycardia and, possibly, signs of life-threatening respiratory muscle paralysis.
Head trauma
Unilateral or bilateral paresthesia may occur when head trauma causes a concussion or contusion; however, sensory loss is more common. Other findings include variable paresis or paralysis, decreased LOC, headache, blurred or double vision, nausea and vomiting, dizziness, and seizures.
Heavy metal or solvent poisoning
Exposure to industrial or household products containing lead, mercury, thallium, or organophosphates may cause paresthesia of acute or gradual onset. Mental status changes, tremors, weakness, seizures, and GI distress are also common.
Herniated disk
Herniation of a lumbar or cervical disk may cause acute or gradual onset of paresthesia along the distribution pathways of affected spinal nerves. Other neuromuscular effects include severe pain, muscle spasms, and weakness that may progress to atrophy unless herniation is relieved.
Herpes zoster
An early symptom of herpes zoster, paresthesia occurs in the dermatome supplied by the affected spinal nerve. Within several days, this dermatome is marked by a pruritic, erythematous, vesicular rash associated with sharp, shooting, or burning pain.
Hyperventilation syndrome
Usually triggered by acute anxiety, hyperventilation syndrome may produce transient paresthesia in the hands, feet, and perioral area, accompanied by agitation, vertigo, syncope, pallor, muscle twitching and weakness, carpopedal spasm, and cardiac arrhythmias.
Hypocalcemia
Asymmetrical paresthesia usually occurs in the fingers, toes, and circumoral area early in hypocalcemia. Other signs and symptoms are muscle weakness, twitching, or cramps; palpitations; hyperactive DTRs; carpopedal spasm; and positive Chvostek’s and Trousseau’s signs.
Migraine headache
Paresthesia in the hands, face, and perioral area may herald an impending migraine headache. Other prodromal symptoms include scotomas, hemiparesis, confusion, dizziness, and photophobia. These effects may persist during the characteristic throbbing headache and continue after it subsides.
Multiple sclerosis
With multiple sclerosis, demyelination of the sensory cortex or spinothalamic tract may produce paresthesia — typically one of the earliest symptoms. Like other effects of multiple sclerosis, paresthesia commonly waxes and wanes until the later stages, when it may become permanent. Associated findings include muscle weakness, spasticity, and hyperreflexia.
Peripheral nerve trauma
Injury to any major peripheral nerve can cause paresthesia — often dysesthesia — in the area supplied by that nerve. Paresthesia begins shortly after trauma and may be permanent. Other findings are flaccid paralysis or paresis, hyporeflexia, and variable sensory loss.
Peripheral neuropathy
Peripheral neuropathy can cause progressive paresthesia in all extremities. The patient also commonly displays muscle weakness, which may lead to flaccid paralysis and atrophy; loss of vibration sensation; diminished or absent DTRs; euralgia; and cutaneous changes, such as glossy, red skin and anhidrosis.
Rabies
Paresthesia, coldness, and itching at the site of an animal bite herald the prodromal stage of rabies. Other prodromal signs and symptoms are fever, headache, photophobia, hyperesthesia, tachycardia, shallow respirations, and excessive salivation, lacrimation, and perspiration.
Raynaud’s disease
With Raynaud’s disease, exposure to cold or stress makes the fingers turn pale, cold, and cyanotic; with rewarming, they become red, throbbing, aching, swollen, and paresthetic. Ulceration may occur in chronic cases.
Seizure disorders
Seizures originating in the parietal lobe usually cause paresthesia of the lips, fingers, and toes. The paresthesia may act as auras that precede tonic-clonic seizures. After the seizure, the patient may complain of headache, fatigue, muscle soreness, and arm and leg weakness.
Spinal cord injury
Paresthesia may occur in partial spinal cord transection, after spinal shock resolves. It may be unilateral or bilateral, occurring at or below the level of the lesion. Associated sensory and motor loss is variable. (See Understanding spinal cord syndromes, page 495.) Spinal cord disorders may be associated with paresthesia on head flexion (Lhermitte’s sign).
Spinal cord tumors
Paresthesia, paresis, pain, and sensory loss along nerve pathways served by the affected cord segment result from spinal cord tumors. Eventually, paresis may cause spastic paralysis with hyperactive DTRs (unless the tumor is in the cauda equina, which produces hyporeflexia) and, possibly, bladder and bowel incontinence.
Stroke
Although contralateral paresthesia may occur with stroke, sensory loss is more common. Associated features vary with the artery affected and may include contralateral hemiplegia, decreased LOC, and homonymous hemianopsia.
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) may cause paresthesia, but its primary signs and symptoms include nondeforming arthritis (usually of hands, feet, and large joints), photosensitivity, and a “butterfly rash” that appears across the nose and cheeks.
Thoracic outlet syndrome
Paresthesia occurs suddenly in this syndrome when the affected arm is raised and abducted. The arm also becomes pale and cool with diminished pulses. Unequal blood pressure between arms may be noted.
Transient ischemic attack
Paresthesia typically occurs abruptly with a transient ischemic attack (TIA) and is limited to one arm or another isolated part of the body. It usually lasts about 10 minutes and is accompanied by paralysis or paresis. Associated findings include decreased LOC, dizziness, unilateral vision loss, nystagmus, aphasia, dysarthria, tinnitus, facial weakness, dysphagia, and ataxic gait.
Vitamin B deficiency
Chronic thiamine or vitamin B12 deficiency may cause paresthesia and weakness in the arms and legs. Burning leg pain, hypoactive DTRs, and variable sensory loss are common in thiamine deficiency; vitamin B12 deficiency also produces mental status changes and impaired vision.
Other causes
Drugs
Phenytoin, chemotherapeutic agents (such as vincristine, vinblastine, and procarbazine), d-penicillamine, isoniazid, nitrofurantoin, chloroquine, and parenteral gold therapy may produce transient paresthesia that disappears when the drug is discontinued.
Radiation therapy
Long-term radiation therapy eventually may cause peripheral nerve damage, resulting in paresthesia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vision Disturbances:
Principal Causes of Vision Disturbances
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Oculardisorders
- Congenitalanomalies
- Globe
- Lens
- Cornea
- Iris
- Vitreous
- Refractive errors
- Myopia
- Hyperopia
- Astigmatism
- Anisometropia
- Strabismus
- Amblyopia
- Trauma
- Infection
- Cataracts
- Glaucoma
- Uveitis
- Anterior uveitis
- Posterior uveitis
- Retinal disorders
- Retinopathyof prematurity
- Retinitis pigmentosa and other retinaldystrophies
- Retinal detachment
- Albinism
- Neoplasm
- Metabolic disorders
- Neurologic disorders
- Lesionsof optic nerve or chiasm
- Optic nerve aplasia
- Optic nerve hypoplasia
- Optic atrophy
- Optic neuritis
- Lesions of optic pathways
- Lesions of visual cortex
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Alteration in Consciousness:
Principal Causes of Alteration in Consciousness
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Headtrauma
- Concussion
- Brain contusion
- Shearing injury
- Cerebral edema
- Intracranial hemorrhage
- Intraparenchymalhemorrhage
- Subdural hematoma
- Epidural hematoma
- Infection/inflammation
- Bacterialmeningitis
- Encephalitis
- Septicemia
- Focal infection
- Brainabscess
- Epidural abscess
- Subdural empyema
- Seizures
- Status epilepticus
- Postictal state
- Brain tumor
- Cerebrovascular disorders
- Cerebralthrombosis
- Cerebral embolism
- Cerebral hemorrhage
- Hydrocephalus
- Obstructive (tumor or other cause)
- Shunt malfunction
- Blood pressure disorders
- Hypotension
- Hypertensive encephalopathy
- Metabolic disorders
- Hypoxic-ischemicencephalopathy
- Acute bilirubin encephalopathy (kernicterus)
- Diabetic ketoacidosis
- Hypoglycemia
- Hypothermia
- Heat-related illness
- Hepatic coma
- Reye syndrome
- Uremia
- Inborn errors of metabolism
- Maplesyrup urine disease
- Nonketotic hyperglycinemia
- Hyperammonemic disorders
- Urea cycledefects
- Carbamylphosphate synthetase deficiency
- Ornithine transcarbamylase deficiency
- Argininosuccinic acid synthetase deficiency(citrullinemia)
- Argininosuccinase deficiency (argininosuccinicaciduria)
- N-acetylglutamate synthetase deficiency
- Arginase deficiency (argininemia)
- Organic acid disorders
- Propionic,isovaleric, and methylmalonic acidemias
- Glutaric aciduria, type II (multipleacyl-CoA dehydrogenase deficiency)
- Multiple carboxylase deficiency
- Pyruvate dehydrogenase complex deficiency
- Pyruvate carboxylase deficiency
- Fatty acid oxidation defects
- Respiratory chain disorders
- Lysinuric protein intolerance
- Hyperornithinemia-hyperammonemia-homocitrullinuriasyndrome
- Transient hyperammonemia of prematurity
- Other metabolic disturbances
- Poisoning, drug overdose, and intoxication
- Carbonmonoxide
- Sedative-hypnotic drugs
- Opiates
- Alcohols
- Ethyl alcohol (ethanol)
- Ethylene glycol
- Isopropyl alcohol
- Methyl alcohol (methanol)
- Anticonvulsants
- Phenytoin
- Carbamazepine
- Valproic acid
- Phenothiazines
- Tricyclic antidepressants
- Anticholinergic drugs
- Salicylates
- Lead
- Organophosphates
- Amphetamines
- Cocaine
- Hallucinogens (psychedelics)
- Iron
- Hydrocarbons
- Clonidine
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Analgesia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anterior cord syndrome.With anterior cord syndrome, analgesia and thermanesthesia occur bilaterally below the level of the lesion, along with flaccid paralysis and hypoactive deep tendon reflexes.
Central cord syndrome.Typically, analgesia and thermanesthesia occur bilaterally in several dermatomes, in many cases extending in a capelike fashion over the arms, back, and shoulders. Early weakness in the hands progresses to weakness and muscle spasms in the arms and shoulder girdle. Hyperactive deep tendon reflexes and spastic weakness of the legs may develop. If the lesion affects the lumbar spine, hypoactive deep tendon reflexes and flaccid weakness may persist in the legs.
With brain stem involvement, additional findings include facial analgesia and thermanesthesia, vertigo, nystagmus, atrophy of the tongue, and dysarthria. The patient may also have dysphagia, urine retention, anhidrosis, decreased intestinal motility, and hyperkeratosis.
Spinal cord hemisection.Contralateral analgesia and thermanesthesia occur below the level of the lesion. In addition, loss of proprioception, spastic paralysis, and hyperactive deep tendon reflexes develop ipsilaterally. The patient may also experience urine retention with overflow incontinence.
Other causes
Drugs.Analgesia may occur with use of a topical or local anesthetic, although numbness and tingling are more common.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Skin, clammy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anxiety.An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, a dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.
Arrhythmias.Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.
Cardiogenic shock.Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.
Heat exhaustion.In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, and hypotension.
Hypoglycemia (acute).Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.
Hypovolemic shock.With hypovolemic shock, generalized pale, cold, clammy skin accompanies a subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, an increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock.The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Paresthesia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Arterial occlusion (acute).With acute arterial occlusion, sudden paresthesia and coldness may develop in one or both legs with a saddle embolus. Paresis, intermittent claudication, and aching pain at rest are also characteristic. The extremity becomes mottled with a line of temperature and color demarcation at the level of occlusion. Pulses are absent below the occlusion, and the capillary refill time is increased.
Arteriosclerosis obliterans.Arteriosclerosis obliterans produces paresthesia, intermittent claudication (most common symptom), diminished or absent popliteal and pedal pulses, pallor, paresis, and coldness in the affected leg.
Arthritis.Rheumatoid or osteoarthritic changes in the cervical spine may cause paresthesia in the neck, shoulders, and arms. The lumbar spine occasionally is affected, causing paresthesia in one or both legs and feet.
Brain tumor.Tumors affecting the sensory cortex in the parietal lobe may cause progressive contralateral paresthesia accompanied by agnosia, apraxia, agraphia, homonymous hemianopsia, and a loss of proprioception.
Buerger's disease.With Buerger's disease exposure to cold makes the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication, which is aggravated by exercise and relieved by rest, is also common. Other findings include weak peripheral pulses, migratory superficial thrombophlebitis and, later, ulceration, muscle atrophy, and gangrene.
Diabetes mellitus.Diabetic neuropathy can cause paresthesia with a burning sensation in the hands and feet. Other findings include insidious, permanent anosmia; fatigue; polyuria; polydipsia; weight loss; and polyphagia.
Guillain-Barré syndrome.With Guillain-Barré syndrome, transient paresthesia may precede muscle weakness, which usually begins in the legs and ascends to the arms and facial nerves. Weakness may progress to total paralysis. Other findings include dysarthria, dysphagia, nasal speech, orthostatic hypotension, bladder and bowel incontinence, diaphoresis, tachycardia and, possibly, signs of life-threatening respiratory muscle paralysis.
Head trauma.Unilateral or bilateral paresthesia may occur when head trauma causes a concussion or contusion; however, sensory loss is more common. Other findings include variable paresis or paralysis, decreased LOC, headache, blurred or double vision, nausea and vomiting, dizziness, and seizures.
Herniated disk.Herniation of a lumbar, thoracic, or cervical disk may cause an acute or a gradual onset of paresthesia along the distribution pathways of affected spinal nerves. Other neuromuscular effects include severe pain, muscle spasms, and weakness that may progress to atrophy unless herniation is relieved.
Herpes zoster.An early symptom of herpes zoster, paresthesia occurs in the dermatome supplied by the affected spinal nerve. Within several days, this dermatome is marked by a pruritic, erythematous, vesicular rash associated with sharp, shooting, or burning pain.
Hyperventilation syndrome.Usuallytriggered by acute anxiety, hyperventilation syndrome may produce transient paresthesia in the hands, feet, and perioral area, accompanied by agitation, vertigo, syncope, pallor, muscle twitching and weakness, carpopedal spasm, and cardiac arrhythmias.
Migraine headache.Paresthesia in the hands, face, and perioral area may herald an impending migraine headache. Other prodromal symptoms include scotomas, hemiparesis, confusion, dizziness, and photophobia. These effects may persist during the characteristic throbbing headache and continue after it subsides.
Multiple sclerosis (MS).With MS, demyelination of the sensory cortex or spinothalamic tract may produce paresthesia—typically one of the earliest symptoms. Like other effects of MS, paresthesia commonly waxes and wanes until the later stages, when it may become permanent. Associated findings include muscle weakness, spasticity, and hyperreflexia.
Peripheral nerve trauma.Injury to a major peripheral nerve can cause paresthesia—commonly dysesthesia—in the area supplied by that nerve. Paresthesia begins shortly after trauma and may be permanent. Other findings are flaccid paralysis or paresis, hyporeflexia, and variable sensory loss.
Peripheral neuropathy.Peripheral neuropathy can cause progressive paresthesia in all extremities. The patient also commonly displays muscle weakness, which may lead to flaccid paralysis and atrophy; a loss of vibration sensation; diminished or absent DTRs; neuralgia; and cutaneous changes, such as glossy, red skin and anhidrosis.
Rabies.Paresthesia, coldness, and itching at the site of an animal bite herald the prodromal stage of rabies. Other prodromal signs and symptoms are fever, headache, photophobia, hyperesthesia, tachycardia, shallow respirations, and excessive salivation, lacrimation, and perspiration.
Raynaud's disease.With Raynaud's disease, exposure to cold or stress makes the fingers turn pale, cold, and cyanotic; with rewarming, they become red and paresthetic. Ulceration may occur in chronic cases.
Seizure disorders.Seizures originating in the parietal lobe usually cause paresthesia of the lips, fingers, and toes. The paresthesia may act as auras that precede tonic-clonic seizures.
Spinal cord injury.Paresthesia may occur in partial spinal cord transection, after spinal shock resolves. It may be unilateral or bilateral, occurring at or below the level of the lesion. Associated sensory and motor loss is variable. (See Understanding spinal cord syndromes, page 465.) Spinal cord disorders may be associated with paresthesia on head flexion (Lhermitte's sign).
Spinal cord tumors.Paresthesia, paresis, pain, and sensory loss along nerve pathways served by the affected cord segment result from spinal cord tumors. Eventually, paresis may cause spastic paralysis with hyperactive DTRs (unless the tumor is in the cauda equina, which produces hyporeflexia) and, possibly, bladder and bowel incontinence.
Stroke.Although contralateral paresthesia may occur with stroke, sensory loss is more common. Associated features vary with the artery affected and may include contralateral hemiplegia, decreased LOC, and homonymous hemianopsia.
Systemic lupus erythematosus (SLE).SLE may cause paresthesia, but its primary signs and symptoms include nondeforming arthritis (usually of the hands, feet, and large joints), photosensitivity, and a “butterfly rash” that appears across the nose and cheeks.
Tabes dorsalis.With tabes dorsalis, paresthesia—especially of the legs—is a common, but late, symptom. Other findings include ataxia, loss of proprioception and pain and temperature sensation, absent DTRs, Charcot's joints, Argyll Robertson pupils, incontinence, and impotence.
Transient ischemic attack (TIA).Paresthesia typically occurs abruptly with a TIA and is limited to one arm or another isolated part of the body. It usually lasts about 10 minutes and is accompanied by paralysis or paresis. Associated findings include decreased LOC, dizziness, unilateral vision loss, nystagmus, aphasia, dysarthria, tinnitus, facial weakness, dysphagia, and an ataxic gait.
Other causes
Drugs.Phenytoin, chemotherapeutic agents (such as vincristine, vinblastine, and procarbazine), d-penicillamine, isoniazid, nitrofurantoin, chloroquine, and parenteral gold therapy may produce transient paresthesia that disappears when the drug is discontinued.
Radiation therapy.Long-term radiation therapy may eventually cause peripheral nerve damage, resulting in paresthesia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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