Paresthesia (Body Tingling): Causes, Evaluation, and Treatment
Paresthesia—abnormal tingling, prickling, or numbness—results from nerve dysfunction.
Common Causes
- Nerve compression/entrapment: Carpal tunnel, cervical/lumbar radiculopathy, thoracic outlet, meralgia paresthetica.
- Nutritional deficiencies: B12 (most common), B6, folate, vitamin E, copper.
- Diabetes mellitus: Diabetic peripheral neuropathy (stocking-glove).
- Alcohol use disorder: Nutritional + direct neurotoxicity.
- Medications: Chemo (platinum, taxanes), metronidazole, isoniazid, antiretrovirals.
- Systemic diseases: Hypothyroidism, renal/liver failure, vasculitis, amyloidosis.
- Neurologic: MS, stroke/TIA, Guillain-Barré, CIDP.
- Toxins: Heavy metals (lead, arsenic, mercury).
Red Flags (Urgent Evaluation)
- Sudden unilateral weakness/numbness (stroke).
- Saddle anesthesia + bowel/bladder changes (cauda equina).
- Rapidly ascending weakness (Guillain-Barré).
Workup
History, neuro exam, labs (B12, TSH, glucose, ESR, SPEP), EMG/NCS, MRI as indicated. Treatment targets underlying cause.
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