DIAGNOSIS CHECKLIST
for Paresthesias

Why: to determine if acute or chronic.

Why: e.g. leg (see leg numbness), thigh (see thigh numbness), foot (see foot numbness), toe (see toe numbness), arm (see arm numbness), elbow (see elbow numbness), hand (see hand numbness), wrist (see wrist numbness), finger (see finger numbness), face (see facial numbness) or lip (see lip numbness). Carpal tunnel syndrome causes paresthesia of the pulps of the thumb, index, middle and half of the ring finger; peripheral neuropathy typically causes a glove and stocking sensory loss to hands and feet; C8 spinal cord or nerve root lesion causes paresthesia of the little finger; C7 spinal cord or nerve root lesion cause paresthesia of the middle finger; C6 spinal cord or nerve root lesion causes paresthesia of the outer side of the forearm and thumb; meralgia paresthetica causes a burning pain with associated paresthesia and tingling over the outer surface of the thigh; L3 nerve root lesion causes paresthesia over the front of thigh; femoral nerve lesion causes paresthesia over the inner aspect of the thigh and leg; cauda equina lesion may cause sensory loss on the buttocks or around the anus; the ophthalmic division of the trigeminal nerve supplies the forehead and surface of the eye; the maxillary division of the trigeminal nerve supplies the skin in the middle of the face and the membranes of the upper part of the mouth, palate and nasopharynx; the third division of the trigeminal nerve supplies the skin of the lower jaw and membranes of the lower part of the mouth.

Why: e.g. symmetrical involvement of both legs suggests peripheral neuropathy. If leg paresthesia is asymmetrical or confined to one limb this may suggest individual nerve disease.

Why: can help determine the cause of paresthesia e.g. carpal tunnel syndrome is usually worse at night.

Why: may help determine the cause of paresthesia e.g. carpal tunnel syndrome symptoms may be relieved by dangling the arm over the side of the bed.

Why: e.g. broken leg or foot may damage nerves and cause leg paresthesia; whiplash injury; Brachial plexus injury; finger injury, hand injury; facial bone fractures including fracture of the zygomatic and orbital bones (bones of the face) may cause paresthesia of the upper lip.

Why: may suggest spinal canal stenosis.

Why: e.g. smoking, diabetes, high blood pressure.

Why: e.g. obesity; pregnancy; ascites (accumulation of fluid in the abdominal cavity); local trauma from belts, trusses or corsets.

Why: Herpes simplex type 1 causes a prodrome of tingling, itching or burning sensation on the lips which usually precede any visible skin changes by 24 hrs. Prodrome is followed by development of fluid filled vesicles which erode to become ulcers on the lips.

Why: e.g. anxiety, panic attacks.

Why: e.g. ascites is a cause of meralgia paresthetica and may caused by cirrhosis of the liver, congestive cardiac failure, nephrotic syndrome, pancreatitis, bowel cancer or ovarian cancer; diabetes mellitus is associated with femoral nerve neuropathy; diabetes, chronic renal failure, leukemia, lymphoma, lupus and amyloidosis can be a cause of peripheral neuropathy; causes of carpal tunnel syndrome include hand trauma, rheumatoid arthritis, Acromegaly, amyloidosis, pregnancy, hypothyroidism, Paget's disease, diabetes mellitus and tophaceous gout; hypocalcaemia may be caused by acute pancreatitis, chronic renal failure, DiGeorge's syndrome, hypoparathyroidism; possible causes of Raynaud's phenomenon include rheumatoid arthritis, lupus erythematosus, systemic sclerosis, polyarteritis nodosa, Buerger's disease, polycythaemia, leukemia, polymyositis , dermatomyositis; hypoparathyroidism is associated with pernicious anemia, Addison's disease, hypothyroidism.

Why: e.g. immediately following removal of thyroid or parathyroid low calcium levels are usually transient.

Why: some medications may cause peripheral neuropathy with a glove and stocking pattern paresthesia including isoniazid, vincristine, phenytoin, nitrofurantoin, cisplatinum, amiodarone; oral contraceptive pill may increase the risk of cavernous sinus thrombosis which may cause facial paresthesia; some medications may cause low calcium levels including calcitonin and diphosphonates; beta-blocker blood pressure medications and ergotamine can aggravate Raynaud's phenomenon.

Why: may assist in determining the risk of Vitamin B1, B12 and folic acid deficiency.

Why: will help determine the risk of alcohol peripheral neuropathy.

Why: certain occupations requiring repetitive motions are at risk of causing work-induced overuse disorders e.g. process and meat workers are at risk of carpal tunnel syndrome due to rapid finger and wrist movement.

Why: e.g. neurofibromatosis 2 may cause facial paresthesia; multiple sclerosis; migraine.

Why: Tabes dorsalis of syphilis may be cause of limb paresthesia.

Why: e.g. neurotoxic shellfish poisoning; ingestion of tetrodotoxin- containing puffer fish.

Why: may suggest lumbar spine spondylosis (degeneration), spinal stenosis, tumor of the cauda equina (distal tip of the spinal cord and its nerves), spondylolisthesis (forward movement of one lumbar vertebrae on the one below it), herniated disk or pelvic tumor.

Why: if also pain in the involved arm this usually suggests herniated cervical disc , spinal cord tumor or cervical spondylosis. Other conditions to consider are brachial plexus neuropathy, thoracic outlet syndrome, cervical rib, Pancoast's tumor, Raynaud's disease, sympathetic dystrophy or various entrapment syndromes such as carpal tunnel syndrome and ulnar nerve entrapment at the elbow.

Why: may suggest a type of brachial plexus; compression of the C8 segment by cervical spondylosis or a disc herniation, median or ulnar nerve lesions; diabetes mellitus causing a peripheral neuropathy.

Why: If incontinence or urine is present with leg paresthesia, this may suggest poliomyelitis, cauda equina tumor or metastatic tumor of the lumbar spine.

Why: if associated with thigh paresthesia may suggest prolapsed disc causing pressure on L2 or L3 nerve roots (note L2 causes buttock numbness also).

Why: would suggest L2 nerve root compression.

Why: if associated with arm paresthesia, may suggest a cervical spinal cord or nerve root lesion due to cervical spondylosis (degeneration) or herniated cervical disc.

Why: may suggest migraine or mass in brain.

Why: e.g. long history of backache; pain initially in the lumbar back area and then radiating distally into buttocks and legs; numbness may be present in groin, medial thigh, big toe or little toe.

Why: e.g. intermittent claudication (cramp like pain in the calves with exercise, relieved by rest), calf pain with rest, occasionally may have transient paresthesia of the leg accompanying the pain and fatigue of claudication.

Why: e.g. sudden severe leg pain, pallor of skin, paresthesia of lower leg, paralysis or weakness of leg.

Why: e.g. frequency of urination, excessive thirst, weight loss, fatigue, increased infections. Diabetes may be complicated by a painful peripheral neuropathy with a glove and stocking pattern paresthesia.

Why: e.g. symptoms begin 7-10 days after an infective illness. It results in muscle paralysis which typically ascends from the lower to the upper limbs. Sensory loss (paresthesia) is usually minimal.

Why: e.g. a burning pain with associated paresthesia and tingling over the outer surface of the thigh. The distribution of pain and paresthesia does not cross the midline. It is due to entrapment of the lateral femoral cutaneous nerve of the thigh.

Why: e.g. pain over the front of thigh, inner aspect of thigh, knee and leg; paresthesia over the front of thigh.

Why: e.g. paresthesia over the inner aspect of the thigh and leg; weakness of the quadriceps muscle in the thigh causing weakness of straightening the leg.

Why: e.g. weakness or paralysis of facial muscles, weakness or paralysis of a limb(s), difficulty speaking or swallowing.

Why: e.g. blurry vision, double vision, dizziness, weakness, paresthesia or tingling in any limbs.

Why: usually associated with anxiety e.g. lightheadedness, faintness, dizziness, breathlessness, palpitations, sweating, dry mouth, agitation, fatigue, paresthesia of the hands, feet or mouth.

Why: e.g. fever, facial pain and tenderness, toothache, post-nasal drip nasal obstruction, runny nose, cough, fever, bleeding nose - may suggest cavernous sinus thrombosis as the cause of facial paresthesia as it is a complication of acute sinusitis.

Why: e.g. headache which may be preceded by temporary unilateral loss of vision (partial or total), transient difficulty with speech together with possible tingling, paresthesia or vague weakness of one side of the face. Nausea and vomiting may follow.

Why: e.g. symptoms of acoustic neuroma, facial weakness, pain or paresthesia.

Why: e.g. progressive deafness, dizziness, paresthesia of that side of the face and facial weakness, followed by clumsiness.

Why: e.g. fever, headache, nausea, vomiting, eye pain, proptosis (forward displacement of the eyeball), double vision, facial paresthesia over the forehead.

Why: e.g. paresthesia around the mouth, muscle cramps, anxiety, facial muscle twitching may be followed by convulsions, stridor and psychosis.

Why: e.g. paresthesia around the mouth, feeling unwell, clumsiness and if severe paralysis of the limb muscles.

Why: e.g. pins and needles, paresthesia around the mouth, cramps, anxiety, muscular contractions (tetany). The symptoms may be followed by seizures, stridor and psychosis.

Why: e.g. as for hypocalcemia.

Why: e.g. prodrome of tingling, itching or burning sensation on the lips which usually precede any visible skin changes by 24 hrs. Prodrome is followed by development of fluid filled vesicles which erode to become ulcers on the lips.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination. May also experience hyperventilation (rapid breathing) which can cause paresthesia around the lips, lightheadedness and tingling in the extremities.

Why: e.g. sudden, unexpected, short-lived episodes of intense anxiety. Intense anxiety episodes usually include hyperventilation (rapid breathing) which may cause paresthesia around the lips, lightheadedness and paresthesia in the extremities.

Why: persistent, irrational fear with a compelling desire to avoid the object or situation occurs in Phobia disorders and may be confused with generalized anxiety disorder or be associated with anxiety.