paresthesia; burning; tingling

Introduction

A sensation of burning, pricking, vibrating, buzzing, crawling, tingling, or tickling. Transient paresthesis may be induced by resting an extremity on the sciatic, peroneal or ulnar nerve, commonly recognized as an extremity 'falling asleep'. Other paresthesias arise without an apparent stimulus.

Etiology

• entrapment of peripheral nerve
• ectopic foci in the central or peripheral nervous system
• perioral paresthesias
  • hyperkalemia
  • hyperventilation (also hands)
  • vertebrobasilar artery territory TIA
  • pharmaceutical agents
    • amprenavir
    • pamidronate
• B-vitamin deficiency
  • thiamine deficiency
  • vitamin B12 deficiency
  • folate deficiency

Clinical manifestations

• Tinel's sign
  • carpal tunnel syndrome
  • cubital tunnel syndrome
• Phalen's sign: carpal tunnel syndrome
• sensory abnormalities of nerve entrapment syndromes
• sensory, motor & reflex changes of radiculopathies
• sensory abnormalities of diabetic polyneuropathy
• abnormalities associated with vitamin B12 deficiency
• signs & symptoms multiple sclerosis
• findings associated with Guillain-Barre syndrome
• perioral paresthesias

Laboratory

• glycated hemoglobin & hemoglobin A1c
• serum vitamin B12 & Schilling test
• cerebrospinal fluid (CSF) analysis
  • rising protein level in Guillain-Barre syndrome
  • oligoclonal banding in multiple sclerosis
• serum calcium, serum albumin
• TSH, free T4
• tests for restless legs syndrome

Diagnostic procedures

• electromyography

Radiology

• magnetic resonance imaging (multiple sclerosis)

Differential diagnosis

• entrapment neuropathy
  • carpal tunnel syndrome
  • cubital tunnel syndrome
  • peroneal neuropathy
  • meralgia paresthetica
• radiculopathy
  • cervical: C5, C6 or C7
  • lumbosacral: L5 or S1
  • usually due to degenerative disc disease
• restless legs syndrome
• diabetic polyneuropathy
• vitamin B12 deficiency
• multiple sclerosis
• Guillain-Barre syndrome
• pharmacologic agents
  • isoniazid; b) vincristine; c) diuretics; d) NSAIDs
• hypocalcemia
• hypothyroidism
• carcinomatous neuropathy
• leprosy
• polycythemia vera
• alcoholism
• connective tissue disorder
  • rheumatoid arthritis
  • systemic lupus erythematosus
• heavy metal poisoning
  • lead
  • arsenic
  • others
• peripheral nerve tumors
• rabies
• focal sensory seizures

Management

• see specific etiology

More general terms

• sign/symptom

More specific terms

• acroparesthesia

Additional terms

• burn
• combustion; burning

Patient information

paresthesia patient information