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Causes of Pinched Nerve

Pinched Nerve Causes: Book Excerpts

• Differential Diagnosis - Paresthesias
• Differential Diagnosis - Paresthesias
• Medical causes - Paresthesia
• Medical causes - Paresthesia
• Medical causes - Paresthesia
• Medical causes - Paresthesia

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Related information on causes of Pinched Nerve:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Pinched Nerve may be found in:

• Hidden causes of Pinched Nerve

Causes of Pinched Nerve: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Pinched Nerve.

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

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

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

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

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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