PARESTHESIA: SYMPTOMS, CAUSES, DIAGNOSIS AND TREATMENT - NEUROPSYCHOLOGY - 2025

The paresthesia is a medical condition characterized by burning sensations, numbness, tingling, itching or burning, usually felt in the upper extremities (arms and hands) and lower (legs and feet) (National Institute of Neurological Disorders and Stroke, 2015).

It usually occurs in a hand or foot and does not usually cause pain. Patients frequently report sensations of numbness, tingling and numbness in the hands, legs, arms, face, feet, or other parts of the body in clinical consultations (National Institute of Neurological Disorders and Stroke, 2015).

This type of sensation can appear temporarily or permanently. In most cases, it is a temporary pathology that is usually caused by the existence of pressure on any of the nerves.

However, it can also be a symptom of acquired injury or a wide variety of diseases or disorders that cause damage to the nervous system.

These sensitive symptoms, especially in the upper extremities, are usually a frequent reason for consultation in primary care services. In most cases, it is due to the development of degenerative pathology or neuropathies due to nerve entrapment.

Due to the fact that they are mild and not very explicit symptoms, in many cases an incomplete evaluation tends to be carried out, underestimating some of the symptoms that can be warning signs of other more severe pathologies (Barrio Ruíz and Mendoza Lanjaine, 2013).

characteristics

On different occasions, many of us, after sitting cross-legged for a while or if we lean on one arm for a long time, feel a tingling sensation or say that a foot or an arm “falls asleep”. We experience paresthesia, that is, a sensation of pricks, numbness or burning, by the foot or by the arm, annoying without causing pain.

The stimulation and sensations of the different parts of our body are carried by the peripheral nerves to the spinal cord. From the spinal nerves, the signals are conducted to the brain through the brain stem. In this way, some interruption in this signaling pathway may result in the development of paresthesia (Sharif-Alhoseini et al., 2012).

Therefore, these types of annoying sensations are produced as a result of pressure on certain nerves.

In addition, they can occur as a result of different conditions, diseases, or disorders that are going to cause nerve damage. Some of the causes can be: brain tumor, stroke, anemia, encephalitis, diabetes, multiple sclerosis, peripheral neuropathy, among others.

Symptoms of paresthesia

People with paresthesia often describe the symptoms and signs they feel through multiple terms. Among them we can highlight: burning, numbness, itching and tingling.

Many patients refer to symptoms as:

• "Abnormal sensations such as itching, pricks as with pins and needles."
• "I notice burning and itching in my hands and feet."
• "My hands feel padded and it is difficult for me to move them."

Symptoms tend to occur more frequently in the arms, legs, hands, and feet, however they can also occur in other parts of the body.

Paresthesia is usually a symptom of other neurological diseases, conditions, or disorders, so paresthesia can also lead to some of the following symptoms:

• Shudder.
• Foot drop.
• Dysarthria
• Numbness.
• Muscular atrophy.
• Ocular dysmetria.
• Restless leg syndrome.
• Difficulty getting to sleep.
• Tingling sensation on the skin

Despite this symptomatic description, these will vary depending on the nerves involved and the severity of the alteration. For example, pressure on the ulnar nerve can cause paresthesia in the little finger and various areas of the hand.

How long does paresthesia last?

Normally, paresthesia occurs temporarily due to some activity or position that exerts prolonged pressure on one or more nerves.

It is common to appear when crossing the legs, when sitting for a long time, sleeping on one of the upper limbs, etc. Therefore, the uncomfortable sensations usually disappear when the pressure is relieved.

However, it can also present in a more severe and even permanent / chronic form due to orthopedic disorders or neurological conditions that cause permanent damage to the nervous system. Furthermore, in more than one case paresthesia is a primary manifestation of some type of serious pathology.

Causes

-Causes of transient paresthesia

The temporary condition will cause tingling and / or numbness that goes away quickly. Some of the causes are described below (Sharif-Alhoseini et al., 2012):

• Obdormition: with this term we refer to the numbness that occurs as a result of prolonged pressure on a nerve. Recovery is immediate.
• Whiplash: after the presentation of this type of pathology, injuries to the cervical soft tissue can cause paraesthetic sensations. Recovery is usually gradual over the course of six months.
• Hyperventilation syndrome: sensations of paresthesia may appear in approximately 35% of patients, as little as three minutes after hyperventilation begins.
• Panic attacks: paresthesias in the mouth, hands and feet, are frequently associated with panic attacks and hyperventilation.
• Transient ischemic attack: some conditions such as thrombosis or embolism can interrupt the normal flow of oxygen to the nervous system and therefore affect the nerve pathways temporarily (or permanently).
• Seizures: Sensations of numbness and numbness may occur both during and after a partial seizure. Stimulation of the vagus nerve in anticonvulsant treatment can also cause some of these symptoms.
• Dehydration: the significant loss of body water can also cause paresthesia.
• Circulatory failure: some circulatory disorders can temporarily (or permanently) affect the nerves and therefore cause paresthesia.

-Causes of prolonged or chronic paresthesia

When symptoms of paresthesia start to appear on a regular or intermittent basis it could be indicative of a more serious problem. Generally, it is a sign of a neurological disease or traumatic damage (Sharif-Alhoseini et al., 2012).

In general, it is frequently due to an infection, inflammation, trauma, or an abnormal process that affects the nerves. It is less frequent that it appears associated with disorders that put the life of the individual at risk, however, it can occur due to the suffering of cerebrovascular disorders and / or tumors (Sharif-Alhoseini et al., 2012).

The main causes of long-term or chronic paresthesia are:

Nervous system disorders

Paresthesia is frequently associated with alterations in both the central and peripheral nervous systems.

In the central nervous system they can be caused by: stroke, intracerebral hemorrhages, lacunar infarcts, brain tumors, head trauma, encephalitis / meinguitis, abscesses, lumbar stenosis, systemic lupus erythematosus, multiple sclerosis, transverse myelitis, lumbar puncture, vitamin b12 deficiency, etc.

In the peripheral nervous system they can be caused by: peripheral neuropathy, neuropathy due to treatment, carpal tunnel syndrome, lateral femoral cutaneous syndrome, femoral neuropathy, tarsal tunnel syndrome, sciatica, herniated disc, cervical spondylosis, pressure paralysis, Charcot's disorder. Marie-Tooth, amyloid neuropathy, neuralgia, etc.

Circulatory disorders

Insufficient blood supply can lead to both temporary and permanent paresthesia. Among them they can be due to arterial, venous or neurogenic syndromes.

Metabolic disorders

Among them we can find diabetes, alcoholism, hypoglycemia, hypothyroidism, hypoparathyroidism, menopause, abnormal levels of calcium / potassium / sodium, uremia, amyloidosis, etc.

Infectious processes

Herpes simplex virus, herpes zosterm virus, canker sores, Lyme disorder, human immunodeficiency virus, leprosy, syphilis, Guillain-Barré syndrome, rabies, etc.

Autoimmune disorders

Rheumatoid arthritis, lupus, Sjogren's syndrome, anemia, diabetes, arthritis, fibriomyalgia, nutritional deficiency.

Viatmine dephitis

B12, b1, b5, b6.

Other factors

Alcoholism, tobacco use, drugs of abuse, heavy metals, nitrous oxide, carbon monoxide, etc.

Forecast

Transient processes usually disappear when the pressure is reversed, however, the treatment of chronic processes implies the treatment of etiological pathologies, which will therefore be different for each one of them.

Furthermore, paresthesia in turn can cause different complications in the underlying disease or disorder. Many people with paresthesia may show difficulties in marking, ambulation, or difficulty in grasping.

Because it is a pathology that affects the nervous system, there is a risk of suffering from chronic pain, disability, difficulty in breathing, paralysis and therefore, a poor quality of life.

On the other hand, when sensitivity is significantly affected, some individuals may be unable to perceive some injuries such as a wound or burn, putting their lives at risk in some cases.

Additionally, numbness in the legs and feet, and especially loss of sensation, can greatly increase the risk of falls.

Diagnosis

Therapeutic intervention will focus primarily on identifying the condition that causes paresthesia. The use of medical history, physical examination and different laboratory tests will be essential for its determination.

In addition, it will also be important to determine whether it is a transient or chronic process due to the implications that the latter may have for the integrity of the individual's nervous system.

Some of the questions to be answered are:

- Where do you notice the numbness or uncomfortable sensations?

- At what point did you begin to perceive them?

- How long do you feel them?

- Do you carry out any type of activity that causes it?

Treatment

The choice of treatment for this condition will largely depend on the cause that is causing it.

If the paresthesia is of a transitory type, the use of measures that try to restore circulation through exercise, massage, or stretching of the affected limb will be useful. These actions will make the tingling and numbness sensation gradually disappear.

In the case of the prolonged presence of paresthesia, when it is due to secondary pathological causes, the treatment will be oriented to the treatment of the etiological diseases and the relief of the symptoms. Some professionals recommend the use of prescription anti-inflammatories such as ibuprofen or aspirin when symptoms are mild.

Apart from these, non-pharmacological interventions are being developed that include nutritional regulation, exercise, avoiding the consumption of alcohol or tobacco, which can help the patient to control the discomfort derived from their symptoms.

References

1. Barrio Ruiz, C., & Mendoza Lanjaine, P. (2013). Patient with paresthesias: that the frequent does not make us forget what is important. FMC, 20 (4).
2. Disabled World. (2016). Paresthesia: Causes, Symptoms, Diagnosing & Treatment. Obtained from Disabled World towards tomorrow.
3. Health Grades. (2014). Paresthesia. Obtained from Right Diagnosis from Healthgrades.
4. Olobot. (2016). Paraesthesia Obtained from Olobot SALUD Spanish Medical Center.
5. Paraesthesia (2016). Retrieved from paresthesia.org.
6. Back Health. (2015). Paraesthesia Obtained from Back Health.
7. Sharif-Alhoseini, M., Rahimi-Movaghar, V., & Vaccaro, A. (2012). Underlying Causes od Presthesia.