STUDY - Technical - New Dacian's Medicine
Paresthesia
(Classical / Allopathic Medicine)
Paresthesia
is an abnormal sensation or combination of sensations -
commonly described as numbness, prickling, or tingling -
felt along peripheral nerve pathways. These sensations
aren't generally painful; unpleasant or painful sensations
are termed dysesthesias. Paresthesia may develop suddenly
or gradually and may be transient or permanent.
A
common symptom of many neurologic disorders, paresthesia
may also result from a systemic disorder or the effects or
a particular drug. The symptom may indicate damage or
irritation of the parietal lobe, thalamus, spinothalamic
tract, or spinal or peripheral nerves - the neural circuit
that transmits and interprets sensory stimuli.
HISTORY:
Ask the patient when the abnormal sensations began, and ask him to describe the character and distribution of the sensations.
Ask the patient about associated signs and symptoms, such as sensory loss and paresis or paralysis.
Review the patient's medical history for neurologic, cardiovascular, metabolic, renal, or chronic inflammatory disorders, such as arthritis or lupus; or a recent traumatic injury or invasive procedure that may have damaged peripheral nerves.
Ask the patient when the abnormal sensations began, and ask him to describe the character and distribution of the sensations.
Ask the patient about associated signs and symptoms, such as sensory loss and paresis or paralysis.
Review the patient's medical history for neurologic, cardiovascular, metabolic, renal, or chronic inflammatory disorders, such as arthritis or lupus; or a recent traumatic injury or invasive procedure that may have damaged peripheral nerves.
PHYSICAL
ASSESSMENT:
Assess the patient's level of consciousness and cranial nerve function.
Test muscle strength and deep tendon reflexes in limbs affected by paresthesia.
Systematically evaluate light touch, pain, temperature, vibration, and position sensation. (See Testing for analgesia.)
Inspect the skin for color and temperature. Palpate pulses.
Assess the patient's level of consciousness and cranial nerve function.
Test muscle strength and deep tendon reflexes in limbs affected by paresthesia.
Systematically evaluate light touch, pain, temperature, vibration, and position sensation. (See Testing for analgesia.)
Inspect the skin for color and temperature. Palpate pulses.
Testing
for analgesia
By carefully and systematically testing your patient's sensitivity to pain, you can determine whether his nerve damage has a segmental or peripheral distribution and help locate the causative lesion.
Tell the patient to relax, and explain that you're going to lightly touch areas of his skin with a small pin. Have him close his eyes. Apply the pin firmly enough to produce pain without breaking the skin. (Practice on yourself first to learn how to apply the correct pressure.)
Starting with the patient's head and face, move down his body, pricking his skin on alternating sides. Have the patient report when he feels pain. Use the blunt end of the pin occasionally, and vary your test pattern to gauge the accuracy of his response.
Document your findings thoroughly, noting areas of lost pain sensation either on a dermatome chart or on peripheral nerve diagrams (if available).
By carefully and systematically testing your patient's sensitivity to pain, you can determine whether his nerve damage has a segmental or peripheral distribution and help locate the causative lesion.
Tell the patient to relax, and explain that you're going to lightly touch areas of his skin with a small pin. Have him close his eyes. Apply the pin firmly enough to produce pain without breaking the skin. (Practice on yourself first to learn how to apply the correct pressure.)
Starting with the patient's head and face, move down his body, pricking his skin on alternating sides. Have the patient report when he feels pain. Use the blunt end of the pin occasionally, and vary your test pattern to gauge the accuracy of his response.
Document your findings thoroughly, noting areas of lost pain sensation either on a dermatome chart or on peripheral nerve diagrams (if available).
SPECIAL
CONSIDERATIONS:
Chemotherapeutic agents, chloroquine, D-penicillamine, isoniazid, nitrofurantoin, parenteral gold therapy, and phenytoin may produce transient paresthesia that disappears when the drug is discontinued.
Chemotherapeutic agents, chloroquine, D-penicillamine, isoniazid, nitrofurantoin, parenteral gold therapy, and phenytoin may produce transient paresthesia that disappears when the drug is discontinued.
PEDIATRIC
POINTERS:
Children may experience paresthesia associated with the same causes as adults. However, they usually can't describe this symptom. Nevertheless, hereditary polyneuropathies are usually first recognized in childhood.
Children may experience paresthesia associated with the same causes as adults. However, they usually can't describe this symptom. Nevertheless, hereditary polyneuropathies are usually first recognized in childhood.
PATIENT
COUNSELING:
Because paresthesia is commonly accompanied by patchy sensory loss, teach the patient safety measures.
Because paresthesia is commonly accompanied by patchy sensory loss, teach the patient safety measures.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.