From the Guidelines
Paresthesia is primarily caused by pressure on or damage to peripheral nerves, with common causes including temporary compression, nerve damage from conditions like diabetes or vitamin B12 deficiency, and certain medications. The condition can manifest as a tingling, burning, or "pins and needles" sensation, often affecting the extremities. According to 1, paresthesia can be a symptom of various vascular diseases, including popliteal arterial entrapment syndrome (PAES), which is characterized by calf claudication, paresthesia, and swelling during exercise. Additionally, Buerger disease, a nonatherosclerotic inflammatory vasculitis, can also present with paresthesias, along with other symptoms such as superficial thrombophlebitis and intermittent claudication 1.
Key factors to consider in the diagnosis and management of paresthesia include:
- Temporary compression of nerves, which can be relieved by changing position
- Nerve damage from conditions like diabetes, vitamin B12 deficiency, or multiple sclerosis
- Certain medications, such as chemotherapy drugs, antiretrovirals, and some antibiotics, which can trigger paresthesia as a side effect
- Alcohol abuse, heavy metal poisoning, and autoimmune disorders like Guillain-Barré syndrome, which can also cause paresthesia
- Nutritional deficiencies, such as vitamin B12 deficiency, which can lead to neurological symptoms, including numbness and paresthesia in the extremities 1
In terms of treatment, addressing the underlying cause is crucial. This may involve:
- Changing position to relieve temporary compression
- Prescribing supplements for nutritional deficiencies
- Adjusting dosages or switching medications for medication-induced paresthesia
- Seeking medical attention for persistent or worsening paresthesia, especially if accompanied by weakness, pain, or other neurological symptoms.
From the Research
Causes of Paresthesia
- Paresthesia may be caused by central or peripheral nervous system abnormalities 2
- Central nervous system-induced paresthesias are most commonly caused by:
- Ischemia
- Structural or compressive phenomena
- Infection
- Inflammation
- Degenerative conditions
- Peripherally induced paresthesias can be caused by:
- Entrapment syndromes
- Metabolic disturbances
- Trauma
- Inflammation
- Connective tissue diseases
- Toxins
- Hereditary conditions
- Malignancies
- Nutritional deficiencies
- Miscellaneous conditions
- Acroparesthesia, a type of paresthesia, can be associated with:
- Rheumatic complaints such as arthritis or myalgia
- Guillain-Barré syndrome
- Vasculitis
- Polyneuropathy, typically distal and symmetric, often due to diabetes
- Mononeuropathy, mainly carpal tunnel syndrome
- Vitamin B12 deficiency
- Monoclonal gammopathy of undetermined significance
- Fabry's disease
- Other diseases 3
Vitamin B12 Deficiency and Paresthesia
- Isolated vitamin B12 deficiency can cause paresthesia, loss of sensation and strength in the limbs, and ataxia 4
- Vitamin B12 deficiency can lead to peripheral neuropathy, which may be underdiagnosed due to poor sensitivity of methods for determining B12 levels 5
- Vitamin B12 supplementation can improve symptoms of B12-responsive neuropathy, including paresthesia 5
- Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy, including symptoms of paresthesia 6