Paresthesia (Tingling and Numbness)


Meaning : Paresthesia (pronunciation: \ˌpar-əs-ˈthē-zhə\; ICD-10: R20.2; ICD-9-CM: 782.0, 355.1) generally refers to abnormal sensations except pain (vs. dysesthesia).

This covers a wide variety of sensations like tingling (pins and needles), itching, pricking, shooting, aching, burning, searing, twisting, or electrical, among others. Most common of these symptoms is the tingling sensation. It is primarily felt on the extremities (hands, feet, arms, and legs) [1, 2, 3].


Causes of Transient Paresthesia

This is the temporary type of paresthesia and is very common because we sometimes tend to position ourselves in a wrong way, like resting your head on your bent forearm over a table or by simply crossing your legs. The following are the other common causes of transient paresthesia [2, 4, 5]:

  • Whiplash injury or injury to the soft tissue of the neck can cause paresthesia of upper extremities after a vehicular accident.
  • Disturbance in sodium ion occurs in hyperventilation syndrome, producing abnormal discharges in the afferent nerves.
  • During panic attacks, an individual may experience paresthesia of the mouth, hands, and feet. Add hyperventilation syndrome to that and it gets worse.
  • After a transient ischemic attack (TIA) or stroke, excess potassium goes out of the cell causing hyperactive muscle contraction, thus paresthesia.
  • Paresthesia during seizures is possible and with its treatment with vagus nerve stimulation, paresthesia is an adverse reaction, thus worsened.
  • Dehydration can also cause paresthesia because of electrolyte imbalance.
    Insufficient blood supply due to acute arterial occlusion by thrombosis, embolism, or aneurysm can cause paresthesia.
  • Beta-alanine supplements have paresthesia as one of the side effects when the dose reaches 800 mg.

Causes of Chronic Paresthesia

Chronic paresthesia is the type of paresthesia that comes and goes and has been happening periodically, thus its other name intermittent paresthesia. Generally, the causes are neurologic diseases. Specific causes are listed below [2, 4, 5, 6]:

Disorders of the Nervous System

Central Nervous System

  1. Cerebrovascular accident (CVA) or stroke: Poststroke paresthesia, Lacunar infarction
  2. Epidural/Subdural hematoma or Subarachnoid hemorrhage
  3. Head trauma
  4. Brain tumor or metastasis: Cavernous angioma, Trigeminal sensory neuropathy, Syringomyelia
  5. Trigeminal trophic syndrome
  6. Encephalitis
  7. Meningitis
  8. Brain abscess
  9. Multiple sclerosis (MS)
  10. Transverse myelitis
  11. Lumbar spinal stenosis
  12. Pernicious anemia
  13. Lumbar puncture

Peripheral Nervous System

  1. Peripheral neuropathy /Entrapment neuropathy
  2. Carpal tunnel syndrome (CTS)
  3. Thoracic outlet syndrome (TOS)
  4. Cubital tunnel syndrome
  5. Tarsal tunnel syndrome
  6. Lateral femoral cutaneous syndrome
  7. Peroneal palsy
  8. Neuralgia
  9. Chronic nerve compression
  10. Meralgia paresthetica
  11. Disc herniation
  12. Cervical spondylosis
  13. Sciatica
  14. Pressure palsy
  15. Piriformis syndrome
  16. Spinal canal stenosis
  17. Charcot-Marie-Tooth disease
  18. Amyloidosis
  19. Spondylolisthesis
  20. Spinal tumors

Disorders of the Circulatory System

  1. Buerger’s disease or thromboangiitis obliterans
  2. Raynaud’s disease

Metabolic Disorders

  1. Diabetic neuropathy
  2. Alcoholic neuropathy
  3. Electrolyte imbalance in potassium, sodium, calcium
  4. Hypothyroidism
  5. Hypoparathyroidism
  6. Insulinoma
  7. Uremia
  8. Hyperaldosteronism
  9. Porphyria
  10. Hypoestrogenemia

Autoimmune Disorders

  1. Rheumatoid arthritis
  2. Systemic lupus erythematosus (SLE)
  3. Fibromyalgia
  4. Sjogren’s syndrome
  5. Polyarteritis nodosa
  6. Systemic sclerosis
  7. Autoimmune vasculitis


  1. Herpes simplex virus (HSV)
  2. Herpes zoster virus causing shingles
  3. Human immunodeficiency virus (HIV)
  4. Guillain-Barre syndrome (GBS)
  5. Lyme disease
  6. Leprosy
  7. Rabies
  8. Neurosyphilis

Other Causes of Paresthesia

  1. Trauma
  2. Acute idiopathic polyneuritis
  3. Chronic relapsing polyneuropathy
  4. Dental paresthesia
  5. Fabry disease
  6. Refsum syndrome
  7. Drug abuse especially opioids, pyridoxine
  8. HIV medications: Didanosine, Zalcitabine, Stavudine
  9. Heavy metal poisoning: Mercury, lead, arsenic
  10. Exposure to industrial toxins
  11. Carbon monoxide poisoning
  12. Nitrous oxide poisoning
  13. Snake bite
  14. Burns
  15. Frostbite
  16. Pink disease
  17. Tobacco smoking
  18. Ito syndrome
  19. Ciguatera (tropical fish) poisoning
  20. Paraneoplastic syndrome


Picture 1: The Nervous System and How it Works
Image Source:

Sensations from different parts of the body are detected by receptors on the peripheral nerves. In the illustration above, we focus on the somatic nervous system under peripheral nervous system because it is type related to paresthesia.The afferent nerves deliver the information to the spinal cord into the brain (mainly to the sensory cortex) through the brainstem and trigeminal nerve. This is now interpreted by the brain and delivers response towards the effectors, in this case, the skeletal muscle, through the spinal cord and efferent nerves. Any disruption in this sensory pathway may cause paresthesia [2, 4, 7].


Diagnosis of the underlying cause of paresthesia requires the patient’s detailed medical history, accurate physical and neurologic examination, and appropriate laboratory tests [8].

Physical examination for paresthesia primarily consists of testing sensations for pain, touch, vibration, temperature and joint position.Stance and gait, which determine the presence of motor and cerebellar problems, are also included to correctly diagnose the cause of the paresthesia.

The examination begins at the center of the problem and proceeds radially until the sensation is perceived as normal. The root and peripheral nerve territories define the distribution of the abnormality [3].

Picture 2: Anterior Peripheral Nerves and Dermatomes
The left (colored) side of this picture shows the dermatomes and on the right are the corresponding peripheral nerves.
Image Source:

Picture 3: Posterior Peripheral Nerves and Dermatomes
The left (colored) side of this picture shows the dermatomes and on the right are the corresponding peripheral nerves.
Image Source:

Picture 4: Diagnosis of Common Nerve Root Lesions
Image Source: McKnight JT & Adcock BB.

Picture 5: Diagnosis of Common Nerve Entrapment Syndrome
Image Source: McKnight JT & Adcock BB.

Laboratory tests indicated for the diagnosis of underlying cause of paresthesia may include the following [2, 9]:

  • Complete blood count (CBC)
  • Chemistry panel (Chem7)
  • Erythrocyte sedimentation rate (ESR)
  • Urinalysis
  • Thyroid stimulating hormone (TSH)
  • Radiograph of affected extremity
  • CT scan
  • MRI
  • Nerve conduction studies
  • Electromyogram (EMG)
  • Myelography
  • Vitamin B12
  • Serum folate
  • Antinuclear antibody (ANA)
  • Serology for syphilis (VDRL or RPR)
  • Nerve biopsy
  • Muscle biopsy
  • Serum immunoelectrophoresis


Cure for paresthesia lies on the treatment of its underlying cause. For transient paresthesia, massage and exercise of the affected extremity frequently relieves this symptom. For chronic paresthesia, the following treatment may be helpful [5, 10]:

  • Acupuncture and massage with aromatic oils or capsaicin are useful in relieving paresthesia.
  • Anti-inflammatory drugs like ibuprofen or aspirin are used for mild paresthesia.
  • Low dose antidepressants such as amitriptyline are used to alter the patient’s perception for paresthesia.
  • For severe paresthesia, opioids may be used as prescribed by the physician.
  • Human nerve growth factor is controversial for restoring damaged nerves.
  • Vitamin supplements are used if the cause of paresthesia is nutrient deficiency.
  • Avoid exposure to underlying causes like alcohol and tobacco.


  1. Merriam-Webster Dictionary. Available from:
  2. McKnight JT & Adcock BB. Paresthesias: A Practical Diagnostic Approach. American Family Physician 1997 (Dec); 56 (9): 2253–2260
  3. Kasper DL, et. al. Harrison’s Principles of Internal Medicine 19th edition. McGraw-Hill Education. 2015.
  4. Alhoseini MS, Movaghar VR, Vaccaro AR. Underlying Causes of Paresthesia, Paresthesia, Dr. Luiz Eduardo Imbelloni (Ed). ISBN: 978-953-51-0085-0. InTech 2012. Available from:
  5. Paresthesia: Causes, Symptoms, Diagnosis & Treatment. Available from:
  6. Paresthesia Causes. Family Practice Notebook. Available from:
  7. Neurons and the Nervous System Part 2. Available from:
  8. NINDS Paresthesia Information Page. National Institute of Neurological Disorders and Stroke. Available from:
  9. Paresthesia. Family Practice Notebook. Available from:
  10. Paresthesia. New Health Guide. Available from:

Published on by under Diseases and Conditions.
Article was last reviewed on September 11th, 2016.

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