From the Guidelines
Right-sided paresthesia is most likely caused by a complex interplay of factors, including cerebrovascular disorders, multiple sclerosis, peripheral neuropathy, nerve compression syndromes, migraines with aura, seizure disorders, or space-occupying lesions like tumors, with the specific etiology depending on the individual patient's presentation and medical history. The etiology of right-sided paresthesia can be multifactorial, and a thorough evaluation is necessary to determine the underlying cause. While the provided evidence 1 focuses on Bell's palsy, which is a condition that affects the facial nerve, it highlights the importance of a comprehensive history and physical examination to identify potential underlying causes of abnormal sensations. Some common etiologies of right-sided paresthesia include:
- Cerebrovascular disorders, such as stroke or transient ischemic attack
- Multiple sclerosis
- Peripheral neuropathy, particularly from diabetes, vitamin B12 deficiency, or alcoholism
- Nerve compression syndromes, such as carpal tunnel syndrome or cervical radiculopathy
- Migraines with aura
- Seizure disorders
- Space-occupying lesions like tumors Metabolic causes, such as hypocalcemia, hypomagnesemia, hyperventilation, and medication side effects, should also be considered. Evaluation of right-sided paresthesia should begin with a thorough neurological examination to localize the lesion, followed by appropriate imaging (MRI or CT of the brain) if central causes are suspected, or nerve conduction studies if peripheral causes are likely. Laboratory tests, including blood glucose, electrolytes, vitamin B12, and thyroid function, can help identify underlying metabolic abnormalities. Treatment of right-sided paresthesia depends on the underlying cause, ranging from addressing metabolic abnormalities to medication management for neuropathic pain (gabapentin, pregabalin, or duloxetine) or surgical decompression for nerve entrapment, as supported by the most recent and highest quality studies 1.