Paresthesia
Paresthesia is an abnormal sensation or combination of sensations—commonly described as numbness, prickling, or tingling—felt along peripheral nerve pathways; these sensations generally aren't painful. Unpleasant or painful sensations, on the other hand, are termed dysesthesias. Paresthesia may develop suddenly or gradually and may be transient or permanent.
A common symptom of many neurologic disorders, paresthesia may also result from a systemic disorder or particular drug. It may reflect damage or irritation of the parietal lobe, thalamus, spinothalamic tract, or spinal or peripheral nerves—the neural circuit that transmits and interprets sensory stimuli.
History and physical examination
First, explore the paresthesia. When did abnormal sensations begin? Have the patient describe their character and distribution. Also, ask about associated signs and symptoms, such as sensory loss and paresis or paralysis. Next, take a medical history, including neurologic, cardiovascular, metabolic, renal, and chronic inflammatory disorders, such as arthritis or lupus. Has the patient recently sustained a traumatic injury or had surgery or an invasive procedure that may have damaged peripheral nerves?
Focus the physical examination on the patient's neurologic status. Assess his level of consciousness (LOC) and cranial nerve function. Test muscle strength and deep tendon reflexes (DTRs) in limbs affected by paresthesia. Systematically evaluate light touch, pain, temperature, vibration, and position sensation. (See Testing for analgesia, pages 32 and 33.) Also, note skin color and temperature, and palpate pulses.
Medical causes
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.
Nursing considerations
▪ Monitor the patient's neurologic status.
▪ Help the patient perform activities of daily living, as needed.
▪ If sensory deficits are present, take measures to protect the patient from injury.
Patient teaching
▪ Teach the patient safety measures.
▪ Discuss signs and symptoms that require medical attention.
▪ Explain the disorder and treatment plan.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Tingling
Read excerpts from these other book chapters related to Tingling:
Medical Books Excerpts
- Paresthesia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Paresthesia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
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