Paresthesias

Paresthesias are abnormal sensations in the extremities in the absence of stimuli. Sensation arises spontaneously and is not always painful. The patient may experience numb, cold, warm, or burning sensations, prickling, tingling or pins and needles, skin “crawling” sensation, or pruritus.

Differential Diagnosis

• 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

Workup and Diagnosis

• History
  –Age of onset, frequency, duration
  –Worsening with movement
  –Recent trauma
  –Exposure to heavy metals or toxins
  –Medications (e.g., chemotherapy, antibiotics)
  –Family history of neuropathy/muscle problems
• Associated symptoms
  –Weakness, falls, pain (back pain, regional pain)
• Physical exam
  –Vital signs (temperature, heart rate, blood pressure)
  –Musculoskeletal exam (joint or muscle tenderness, spine tenderness, bony pain, neck stiffness)
  –Neurologic examination: Detailed sensory examination (vibratory, pinprick, position sense) to evaluate for nerve root, spinal cord, or central etiology

• Initial labs
  –CBC, chemistry panel, U/A, TSH, ESR
• Secondary evaluation
  –Serum folate, serum B12, syphilis serology, ANA
  –Electromyogram, nerve conduction velocities
  –X-ray of the affected extremity
  –CT or MRI of the brain
  –Nerve biopsy
  –Muscle biopsy
  –Serum electrophoresis

Treatment

• Paresthesias emanating from peripheral neuropathy: Trial of amitriptyline, gabapentin, or carbamazepine
• Transverse myelitis and acute flares of multiple sclerosis are often treated with steroids
• Acute cerebrovascular events are treated according to the cause; anticoagulant therapy is sometimes indicated
  
• Entrapment neuropathies or pressure palsies
  –Treated supportively with bracing
  –Sometimes require release of tensor fascia
• Vitamin B12 deficiency
  –Treated with exogenous administration of B12
• Uremic neuropathy responds to dialysis; may often be cured with renal transplantation
• Paresthesias resulting from connective tissue diseases or infectious etiologies often improve after treatment of the underlying disease
• Drug-induced and toxin-related paresthesias typically improve after cessation of the offending agent

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Skin pain

Read excerpts from these other book chapters related to Skin pain:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Skin pain

• Back to symptom: Skin pain: Introduction (review 106 causes)
• Next Book Extract About Skin pain: SKIN ULCERS (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Skin pain

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: SKIN ULCERS (Differential Diagnosis in Primary Care)

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