Paresthesia, a Neurological Issue
Paresthesia, or a tingling pins and needles sensation, is one of the neurological issues that someone with lupus may experience. I decided to research it because I am experiencing it now. It is a strange thing indeed. If you have ever been to the dentist and numbed, you will understand. It is the feeling you get as you become un-numb, partial feeling and lots of tingling. It is not painful, but it is uncomfortable and worrisome. I mean, I do not have paralysis, as in palsy, but it still can be disconcerting. I am able to talk, but my face feels numb.
Anyhoo, in the interest of educating others, I looked up this information and thought I would share it. Enjoy!
This information comes from the following link: http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm
What is Paresthesia?
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.
Most people have experienced temporary paresthesia — a feeling of “pins and needles” — at some time in their lives when they have sat with legs crossed for too long, or fallen asleep with an arm crooked under their head. It happens when sustained pressure is placed on a nerve. The feeling quickly goes away once the pressure is relieved.
Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage. Paresthesia can be caused by disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), multiple sclerosis, transverse myelitis, and encephalitis. A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia. Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain. Diagnostic evaluation is based on determining the underlying condition causing the paresthetic sensations. An individual’s medical history, physical examination, and laboratory tests are essential for the diagnosis. Physicians may order additional tests depending on the suspected cause of the paresthesia.
Is there any treatment?
What is the prognosis?
What research is being done?
Further information about Paresthesias is below, or review more specific information about these types of Paresthesias: Finger paresthesia, Hand paresthesia, Foot paresthesia, Arm paresthesia, Toe paresthesia, Leg paresthesia, Ankle tingling/paresthesias, Back tingling/paresthesias or other types.
Paresthesias can affect various parts of the body. Hands, fingers, and feet are common sites but all are possibilities. Afflictions of specific nerves or spinal nerves can also cause paresthesias in particular skin areas of the body.
Parethesias with simple causes such as pressing on a nerve are usually reversible. Certain other nerve conditions such as peripheral neuropathy (often from diabetes), lupus complications, Guillain-Barre syndrome, or multiple sclerosis are also possible causes of parethesias. Because of the variety of possible causes, any abnormal sensation needs prompt professional medical investigation
Diagnostic Test list for Paresthesias:
- General appearance – abnormal posture, muscle wasting, abnormal limb movements.
- Mental state examination – including appearance, behavior, rate and continuity of speech, mood, affect, thought content, evidence of any hallucinations or abnormal beliefs, orientation to time, place and person, attention and concentration, short-term memory, insight and judgement. May help detect and evaluate anxiety and panic states which may cause hyperventilation (rapid breathing) and consequent paresthesia around the lips, lightheadedness and tingling in the extremities.
- Physical examination
- Examine for physical signs of low calcium including Chvostek’s sign (gentle tapping over the facial nerve causes twitching of the facial muscles) and Trousseau’s sign (inflation of the blood pressure cuff above diastolic blood pressure for 3 minutes causes muscular contraction of the fingers and wrist)
- Examination of cranial nerves ( if affected would suggest a diagnosis of cerebrovascular disease , a mass in the brain, migraine or multiple sclerosis)
- Test muscle tone, power, reflexes and co-ordination of upper limbs
- Test sensation of upper limbs ( including pain , touch , temperature and vibration sensation)
- Examine each nerve of the upper limb (including radial , median, ulnar nerve and also brachial plexus)
- Test muscle tone, power, reflexes and co-ordination of lower limbs
- Test sensation of lower limbs ( including pain , touch , temperature and vibration sensation)
- Examine each nerve of the lower limb (including lateral cutaneous nerve of the thigh, femoral nerve, sciatic nerve and common peroneal nerve)
- Feel the pulses in the legs – if reduced or absent should suggest peripheral atherosclerosis (hardening of the arteries) or obstruction of the abdominal aorta and its branches by atherosclerosis.
- Examine for a positive straight leg raising test (straightening the leg at the knee while lying on a bed causing pain in thigh, buttock and back) and/or a reduced ankle reflex- indicates herniated disk of L4-5 or L5-S1, lumbar spondylosis, spinal stenosis, cauda equina tumor or spondylolisthesis
- Examine for a positive femoral stretch test (with the person laying on their stomach, flex knee with hip lifted in extension causes pain in the front of the thigh and the back) or a decreased knee jerk – indicates a herniated disk of L3-4 or L2-3 or lumbar spondylosis.
- Blood tests
- Full blood test and ESR
- Calcium level to detect hypocalcaemia which may cause facial paresthesia
- Elevated phosphate levels may cause hypocalcaemia
- Low parathyroid hormone may cause hypocalcaemia
- Low Vitamin D metabolite levels may cause hypocalcaemia
- Renal function tests to detect chronic renal failure which may cause hypocalcaemia
- Blood glucose and/or glucose tolerance test to rule out diabetes if peripheral neuropathy or peripheral nerve lesions are present
- Arthritis screen (including Rheumatoid factor, ANA, ENA and ds DNA autoantibodies)
- B12 and folic acid levels
- Thyroid function tests to rule out hypothyroidism (which may cause carpal tunnel syndrome) and hyperthyroidism
- Serum protein electrophoresis to diagnose various collagen vascular diseases that may cause neuropathy
- Syphilis serology, if indicated
- HIV test, if indicated
- Lead or arsenic levels, if suspect lead or arsenic neuropathy
- Urine tests
- Porphyrins and porphobilinogen to rule out Porphyria
- 24 hour urinary calcium
- Radiological investigations (depending on area that is numb)
- X-Ray of the lumbosacral spine
- CT Scan of the lumbosacral spine
- MRI Scan of the lumbosacral spine, may be necessary
- Myelography may be useful when contemplating surgery
- Neck X-ray (look for cervical rib which may cause thoracic outlet syndrome
- Upper Thoracic spine X-Ray
- Elbow , forearm, Shoulder X-ray
- Wrist and Hand X-Ray
- CT Scan or MRI of Cervical spine, if there is paresthesia of the upper limb(s) but nil paresthesia of the face or there are cranial nerve signs; can detect nerve root entrapment in the intervertebral foramina of the cervical spine or a disc prolapse
- CT Brain or brain stem if there is paresthesia of an extremity and also paresthesia of the face or cranial nerve signs to detect cerebrovascular disease or mass in brain such as a tumor or abscess
- MRI Brain and Spinal cord, if CT Scan is not helpful or inconclusive; or to detect multiple sclerosis
- X-ray and CT scan of petrous temporal bone, if facial paresthesia, a history of trauma and have 7th nerve palsy
- X-Ray of paranasal sinuses to detect infection which may cause cavernous sinus thrombosis and facial paresthesia
- Carotid ultrasound scan, if stroke is suspected
- Cerebral angiogram, if suspect cavernous venous thrombosis
- Nerve conduction velocity study – to establish the presence of a neuropathy.
- Electromyelogram (EMG) – to establish the presence of a neuropathy such as entrapment syndromes of peripheral nerves.
- Spinal tap- if suspect multiple sclerosis, Guillain-Barre syndrome or neurosyphilis.
- Electrophysiological tests such as visual-evoked response (VER) – may be required to diagnose Multiple sclerosis.
- Lymph node biopsy- if sarcoidosis is suspected.
- Muscle biopsy – if suspect various collagen diseases