خلاصه
Paraesthesias are abnormal sensory symptoms typically characterised as tingling, prickling, pins and needles, or burning sensations. They may be transient or persistent, limited in distribution or generalised, and may involve any portion of the body innervated by sensory or afferent nerve fibres. They may occur in isolation or in association with reduced or absent sensation. The symptoms usually occur spontaneously. Paraesthesias can be caused by a dysfunction or abnormality affecting any level of the somatosensory pathway. However, the most common causes affect peripheral sensory nerves.
The somatosensory pathway
Primary afferent or sensory nerve fibres originate as unmyelinated nerve endings in the epidermis or as myelinated nerve fibres associated with sensory receptor structures in the dermis. They are organised distally as cutaneous branches of peripheral nerves or as the sensory components of mixed sensory and motor peripheral nerves, such as the median nerve in the hand or the tibial nerve in the leg. In the extremities, the peripheral sensory nerves become components of either the brachial plexus for the upper extremities or the lumbosacral plexus for the lower limbs. Proximal to the plexus, sensory nerve fibres remain combined with the motor nerve fibres in the spinal nerve roots, with the sensory nerve fibres projecting centrally to the dorsal root ganglion. The dorsal root ganglia contain the sensory neuronal cell bodies and are found alongside the spinal cord for the neurons innervating the extremities and trunk, or in the cranial nerve nuclei in the brainstem for the cranial nerves. The central process of the dorsal root ganglion neuron extends centrally, via the dorsal root, into the dorsal horn of the spinal cord, or from the cranial nerve sensory nuclei, with central projections through the thalamus and ultimately to the somatosensory cortex.
تشخيص افتراقی
- Common
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- Carpal tunnel syndrome
- Ulnar neuropathy
- Peroneal neuropathy
- Meralgia paraesthetica
- Cervical radiculopathy
- Thoracic radiculopathy
- Lumbosacral radiculopathy
- Spinal cord compression
- Multiple sclerosis
- Distal symmetric polyneuropathy (DSP)
- Diabetes mellitus
- Hypothyroidism
- Vitamin B1 deficiency
- Vitamin B6 deficiency
- Vitamin B12 deficiency
- Vitamin E deficiency
- Drug toxicity
- Alcoholic neuropathy
- Stroke/transient ischaemic attack
- Migraine with aura
- Peripheral vascular disease
- Panic attack with hyperventilation
- Charcot-Marie-Tooth disease
- Hereditary sensory and autonomic neuropathy (HSAN)
- Hereditary neuropathy with liability to pressure palsy (HNPP)
- Uncommon
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- Brachial plexopathy
- Lumbosacral plexopathy
- Tibial neuropathy
- Trigeminal neuropathy
- Acute demyelinating encephalomyelitis
- Guillain-Barre syndrome
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Chronic inflammatory demyelinating sensory polyradiculopathy (CISP)
- Uraemia
- Hypocalcaemia
- Copper deficiency
- Heavy metal poisoning
- Radiation
- Hexane
- Ciguatera or saxitoxin poisoning
- HIV neuropathy
- Leprosy
- Herpes simplex infection
- Neurosyphilis
- Herpes zoster infection (shingles)
- Lyme disease
- Conversion and somatisation disorders
- Inborn errors of metabolism
- Rheumatoid arthritis
- SLE
- Churg-Strauss syndrome
- Granulomatosis with polyangiitis (Wegener's)
- Polyarteritis nodosa
- Microscopic polyangiitis
- Sjogren's syndrome
- Sarcoidosis
- Monoclonal protein production
- Partial epilepsy
- Paraneoplastic sensory neuropathy or ganglionopathy
- Intravascular lymphoma
- Neuro-Behcet's disease
- Wartenberg's migrant sensory neuritis
- Numb chin syndrome
- Peripheral neuropathy after bariatric surgery
