Paresthesias are unusual sensations that occur against the background of sensory disorders. Include a feeling of crawling goosebumps, tingling, burning. They are observed with damage to peripheral nerves, injuries and diseases of the spinal cord and brain, and some other pathologies. The cause is determined by complaints, medical history, results of neuroimaging, electrophysiological studies and laboratory tests. Treatment - painkillers, antispasmodics, psychoactive drugs, symptomatic therapy, physiotherapy, surgery.
Paresthesias are one of the most common sensory disorders. As a rule, they are felt on the skin, less often on the mucous membranes of the oral cavity and pharynx. In healthy people, they appear briefly after a blow or compression of a part of the body with impaired blood supply (more often when sleeping in an uncomfortable position), disappear within a few minutes. Along with hypo- and hyperesthesia, dysesthesia and hyperpathia are observed in neuropathic pain syndrome. Possible causes of the symptom are:
- Diseases of the peripheral nerves: mononeuropathies, tunnel syndromes, polyneuropathy, plexitis, ganglionitis, ganglioneuritis, neuralgia.
- CNS damage: spinal and craniocerebral injuries, tumors, circulatory disorders.
- Other neurological pathologies: migraine, Ekbom's syndrome.
- Peripheral vascular diseases: erythromelalgia, Raynaud's syndrome, varicose veins, endarteritis obliterans, atherosclerosis and thromboangiitis.
- Dental diseases: glossodynia, xerostomia, glossitis.
- Metabolic disorders: hypoparathyroidism, hypovitaminosis B1.
- Mental disorders: hysteria, depression, neurasthenia, pharyngeal neurosis.
Why do paresthesias occur?
Neuropathy
They are a polyetiological disease, develop after injuries, with compression of the nerves, diseases of the musculoskeletal system (arthritis, tendinitis, exostoses). Manifested by muscle weakness, pain, paresthesia. In the later stages, numbness develops, contractures form. The localization of the zone of sensory, autonomic and motor disorders is determined by the affected nerve trunk. When the upper limb is involved, the following nerves may be affected:
- Elbow. The hypotenar area and 4-5 fingers become numb. Weakness of the hand is noted when trying to pick up an object. Symptoms are often worse in the morning.
- Median. Hypesthesia and paresthesia are found on the radial side of the palm, partially in the projection of the fingers. Patients are in severe pain. The movements of 1-3 fingers are difficult. A type of damage to this nerve is carpal tunnel syndrome, accompanied by frequent nocturnal pain attacks.
- Ray. Sensory disturbances extend to the shoulder, rear of the forearm, 1-3 fingers. Muscular hypotrophy, "hanging brush" are revealed.
Along with the above signs, when the legs are affected, characteristic changes in gait are often observed. The topic depends on the nerve involved:
- Sciatic. The leading symptom is sciatica - a shooting or burning pain along the back of the leg. Paresthesias are localized in the area of the foot and the posterior surface of the lower leg.
- Femoral. Paresis of the quadriceps is found. Patients have difficulty running and walking. Sensitivity disorders cover the inner edge of the foot, the anteromedial surface of the leg throughout.
- External cutaneous nerve of the thigh. Sensory disturbances occupy a central place in the clinical picture. Numbness and paresthesia occur in some areas along the lateral side of the thigh, spread to the entire outer and partially anterior surface.
- Tibial. Can't get up on toes. Disorders of pain and tactile sensitivity are determined on the lower leg. Tarsal tunnel syndrome develops burning pain in the sole. With calcanodynia, pain, paresthesia and numbness are disturbing in the heel area.
- Peroneal. Characterized by a cock's gait, neuropathic pain on the anterolateral side of the lower leg and rear of the foot.
Plexites
Occur after traumatic injuries, birth injuries, with tumors, lymphadenitis, infectious diseases. Most often unilateral. Manifested by spontaneous pain, aggravated by pressure in the projection of the nerve plexus. With progression, paresis develops, paresthesias grow, turn into hypesthesia and numbness. In the outcome, recovery is observed (often incomplete). The symptom is provoked by the following plexitis:
- Cervical. There are pains in the neck, radiating to the ear and back of the head. Possible torticollis.
- Brachial. With a total form, pain, paresthesia and muscle atrophy cover the entire limb, with the lower and upper arm partially affected.
- Lumbar. Neuropathic low back pain radiates to the buttock and anterior thigh.
ganglionitis, ganglioneuritis
Inflammation of the nerve node and adjacent nerve trunks is characterized by paroxysmal diffuse burning pains without a clear localization lasting from several minutes to several hours, autonomic disorders and various sensory disorders: paresthesia, hypesthesia, hyperesthesia. The sign is observed with the following ganglionitis and ganglioneuritis:
- Pterygopalatine node. Worried about spontaneous pain attacks in the eye, base of the nose, upper jaw and hard palate, spreading to the neck, back of the head, ear and temple. Half of the face reddens, abundant salivation and lacrimation are detected.
- Ear node. Vegetalgia is typical in the ear area and in front of the external auditory canal, radiating to the neck, shoulder girdle and back of the head. Ear congestion, hypersalivation are possible.
- Sublingual and submandibular nodes. The pain is localized under the jaw, in the tongue and sublingual region, radiating to the back of the head, temple, neck, and shoulder girdle. Swelling of the tongue, hypersalivation, less often - xerostomia are found.
With cervical ganglioneuritis, pain and paresthesia appear in the face, head, arm, upper chest, and in the chest - in the chest. Lumbar and sacral ganglioneuritis is characterized by the spread of symptoms to the abdomen and lower limbs.
paresthesia
neuralgia
Patients are concerned about short-term paroxysms of shooting pain, resembling an electric shock. Paresthesias, as a rule, are expressed unsharply, are observed in the interictal period, accompany the following neuralgia:
- trigeminal nerve - prosopalgia cover half of the face;
- occipital nerve - the entire back of the head or half of it is involved;
- intercostal neuralgia - there are "lumbago" along the intercostal space.
Polyneuropathies
In most cases, the upper and lower extremities are symmetrically affected, the symptoms spread from the distal to the proximal. Paresthesia, dysesthesia and hyperesthesia are determined, which are subsequently replaced by hypesthesia. Flaccid paresis is formed, reflexes are reduced, vegetative-trophic disorders occur. The clinical picture of polyneuropathy varies somewhat depending on the etiology of the disease.
Alcoholic polyneuropathy manifests with paresthesias. At first, the symptom occurs briefly after being in an uncomfortable position, gradually progresses, is supplemented by muscle weakness, the formation of zones of numbness in the form of "gloves" and "socks". The lower extremities are more affected. With diabetic polyneuropathy, tingling, burning, numbness are noted. Concerned about dysesthesia, hyperesthesia, short-term cramps in the feet, toes and hands. Trophic disorders develop.
Polyneuropathy of pregnant women is formed acutely or subacutely. Paresis and sensory disturbances are aggravated against the background of repeated vomiting with toxicosis. In acute inflammatory polyneuropathy (for example, with Guillain-Barré syndrome), flaccid tetraparesis plays a leading role in the clinical picture, paresthesia fades into the background. CVD occurs in several ways. Complete regression of symptoms, progressive or recurrent course are possible.
Myelopathy
The symptom is observed with such myelopathy as:
- Discogenic: disc protrusion, intervertebral hernia, formation of adhesions after injuries and operations on the spine.
- Compression: dislocations, subluxations and compression fractures of the vertebrae, tumors of the spinal cord, hemorrhages under the membranes (traumatic, iatrogenic).
- Post- traumatic: spinal contusions in case of bruising of the spine, penetrating wounds, damage to the roots by displaced bone fragments.
- Vascular: violations of the spinal circulation, malnutrition of the nervous tissue with vascular hypoplasia, aneurysm, thrombosis, embolism, vasculitis, periarteritis nodosa, atherosclerosis.
- Infectious: acute enteroviral transient myelopathy, AIDS, spinal epidural abscess, syphilitic myelopathy.
Other lesions of roots and spinal cord
Paresthesias accompany a number of diseases and conditions with incomplete interruption of the spinal cord or damage (irritation, compression) of individual nerve roots. Occur below the level of the lesion in the corresponding zone of innervation. With radiculitis, diffuse pains are observed at the initial stage, subsequently a picture of radicular syndrome is formed, hypesthesias and muscle weakness are added:
- Neck sciatica. The pain syndrome worries in the neck, upper arm and chest, paresthesias are detected in the distal limbs.
- Thoracic sciatica. The affected area covers the arm and chest.
- Lumbar sciatica. Patients complain of pain and paresthesia in the foot, lower leg or thigh.
Acute transverse myelitis is often diagnosed in multiple sclerosis and can complicate autoimmune and infectious diseases. Debuts neuropathic pain, which is joined by common sensory disorders. Both hyperesthesias and burning paresthesias, and lack of sensitivity are possible. The symptom can also be detected in spinal cord injuries, primary and metastatic neoplasia of the spinal cord.
Other neurological diseases
Taking into account the localization of the pathological process, sensory and motor disorders appear in separate areas or in half of the body (left or right), can be combined with cerebellar and vestibular disorders, signs of damage to the cranial nerves, and other focal symptoms. Paresthesias are found in the following conditions:
- tumors - a gradual increase in neurological symptoms is characteristic;
- transient stroke - muscle weakness, numbness and hypoesthesia are short-term, disappear within a day;
- stroke - the clinical picture is formed suddenly, as a result, persistent signs of a neurological deficit are formed;
- TBI - residual effects are detected in severe and moderate injuries: brain contusion, fractures of the vault and base of the skull, open injuries.
Paresthesias are central to the picture of restless leg syndrome. Strange sensations appear at night, deprive patients of sleep, force them to get up and move. They are localized mainly in the legs and feet, eventually spread to the thighs, arms, perineum. The symptom sometimes worries migraine patients. It occurs on the affected side, more often in the temple area.
Angiotrophoneurosis
With Raynaud's syndrome, paresthesias become the result of vasospasm, are observed at an early stage of ischemic paroxysm, are replaced by aching pains, bursting. Patients with erythromelalgia are disturbed by bouts of burning or baking pain in the feet, hands, less often in the perineum, ears or nose. Over time, pain episodes become more frequent and lengthened, paresthesia, hyperesthesia, and hyperpathia join.
Peripheral vascular disease
Paresthesias are a characteristic symptom of obliterating pathologies of peripheral vessels: endarteritis, atherosclerosis, thromboangiitis. They are associated with muscle cramps, chilliness, hypoesthesia and intermittent claudication. The manifestation is also found in the later stages of varicose veins, supplemented by swelling, pain, and trophic disorders.
Dental diseases
Paresthesia of the mucous membranes are determined in some dental diseases:
- Glossitis. The symptom appears in the initial stages, includes discomfort, burning. The tongue is edematous, taste recognition is difficult. Eating and talking cause discomfort due to pain.
- Glossodynia. Paresthesias are considered the main manifestation of pathology. Patients complain of crawling, itching, tingling, feeling of hair on the tongue. Initially, unusual sensations are short-term, later they become permanent.
- Xerostomia. Due to insufficient salivation, patients are concerned about burning and dry mouth. Eating causes discomfort. Infectious complications often develop.
Other reasons
Possible causes of paresthesias are:
- Infectious diseases. The symptom occasionally occurs with significant hyperthermia against the background of acute infections and severe local purulent processes (abscesses, phlegmon).
- Endocrine and metabolic diseases. Neurological manifestations are formed against the background of metabolic failures. With hypovitaminosis B1, polyneuropathy develops. With hypoparathyroidism, paresthesias and muscle cramps are detected.
- Mental disorders. In patients with hysteria, depression and neurasthenia, paresthesias do not have an organic basis; they develop as part of the somatization of mental disorders. With neurosis of the pharynx, the symptom is determined in the affected area, supplemented by perspiration and pain.
Neurologist examination
Diagnostics
Establishing the etiology of paresthesia is the responsibility of a neurologist. If necessary, patients are referred for consultations to other specialists: a phlebologist, a vascular surgeon, an endocrinologist. With unusual sensations on the oral mucosa, a dentist examination is recommended. The doctor determines complaints, studies the anamnesis of life and disease. Finds out when paresthesia first appeared, how the symptom has changed over time. To clarify the diagnosis, a detailed examination is carried out:
- Neurological examination. Provides for the study of sensitivity, reflexes, muscle strength. The neurologist performs palpation of the affected area, evaluates pain at the exit points of the nerves. Pain perception is checked with a needle, tactile - with a cotton swab or feather. To study muscle strength, detect specific signs of certain pathologies, various functional tests are used.
- electrofunctional methods. They include electromyography, electroneurography, somatosensory, trigeminal and skin evoked potentials. Indicated for neuropathies, plexitis, ganglioneuritis, trigeminal neuralgia, etc. They make it possible to confirm damage to the nerve trunk, establish its severity and localization, assess the deep sensitivity and functional state of the autonomic nervous system.
- Neuroimaging. Magnetic resonance imaging is considered the most informative technique, CT is less commonly used. Depending on the proposed pathological process, the patient may be assigned an MRI of the cranial nerves, brain or spinal cord. Methods make it possible to clarify the nature of the disease (tumor, hemorrhage, etc.). If a vascular origin of neurological symptoms is suspected, MR angiography is recommended.
- Vascular research. Indicated for varicose veins and obliterating diseases. Ultrasound techniques are used (duplex scanning, dopplerography). Peripheral arteriography, thermography, rheovasography, oscillography, capillaroscopy can be performed. To detect vascular spasm in arterial lesions, functional tests (paravertebral or pararenal blockade) are performed.
- Laboratory tests. To clarify the etiology of polyneuropathy, toxicological studies, genetic tests, antibody tests, and blood sugar determination are performed. In case of metabolic disorders, the level of vitamins, parathyroid hormone, phosphorus and calcium is assessed. In infectious diseases, a microbiological study, PCR, ELISA are performed. Morphological analysis is carried out to determine the type and degree of malignancy of neoplasia.
With the defeat of solid structures, tunnel syndromes, X-ray techniques (X-ray, CT) are recommended. In case of mental disorders, consultation with a psychiatrist, psychological testing, pathopsychological examination are indicated.
Treatment
Conservative therapy
In diseases accompanied by paresthesia, the following therapeutic measures are carried out:
- Elimination of neuropathic pain. With intense pain syndrome, narcotic and non-narcotic analgesics, antispasmodics, tricyclic antidepressants, tranquilizers, sedatives are prescribed. A quick effect is provided by blockades of nerves and trigger points.
- Etiopathogenetic therapy. Taking into account the cause of the disease, it may include correction of insulin therapy, calcium supplements, vitamin B1, ganglion blockers, adrenoblockers, detoxification, administration of human immunoglobulin and other methods.
- Other techniques. Showing neurotrophic drugs, ATP, vitamins B, C, PP. A good result is achieved during physiotherapy procedures. Exercise therapy, massage, reflexology, galvanization, ultraphonophoresis, inductothermy are used. Sometimes manual techniques are used.
Surgery
Depending on the cause of paresthesia, the following operations can be performed:
- Neuropathy: decompression, neurolysis of peripheral nerves, excision of the tumor of the nerve trunk.
- Trigeminal neuralgia: microvascular decompression of the trigeminal nerve root, percutaneous rhizotomy.
- Ganglionitis, vascular disease: cervical, thoracic, lumbar or periarterial sympathectomy.
- Myelopathy, sciatica: neoplasm excision, discectomy, microdiscectomy, puncture disc decompression, facetectomy, laminectomy.
- CNS lesions: transcranial, endoscopic or stereotaxic removal of hematomas, decompressive craniotomy, excision of neoplasia, thrombolysis in ischemic stroke.