Evaluation of paresthesias

Last reviewed: 12 Aug 2025
Last updated: 28 Aug 2025

Summary

Differentials

Common

  • Carpal tunnel syndrome
  • Ulnar neuropathy at elbow (UNE)
  • Fibular (peroneal) neuropathy
  • Meralgia paresthetica
  • Cervical radiculopathy
  • Thoracic radiculopathy
  • Lumbosacral radiculopathy
  • Spinal cord compression
  • Multiple sclerosis
  • Distal symmetric polyneuropathy (DSP)
  • Diabetes mellitus
  • Hypothyroidism
  • Vitamin B1 deficiency
  • Vitamin B6 deficiency or excess
  • Vitamin B12 deficiency
  • Vitamin E deficiency
  • Drug toxicity
  • Alcoholic neuropathy
  • Stroke/transient ischemic attack
  • Migraine with aura
  • Peripheral vascular disease
  • Panic attack with hyperventilation
  • Charcot-Marie-Tooth (CMT) disease
  • Hereditary sensory and autonomic neuropathy (HSAN)
  • Hereditary neuropathy with liability to pressure palsy (HNPP)
Full details

Uncommon

  • Brachial plexopathy
  • Lumbosacral plexopathy
  • Tibial neuropathy
  • Trigeminal neuropathy
  • Acute demyelinating encephalomyelitis
  • Acute inflammatory demyelinating polyneuropathy (AIDP)
  • Chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Chronic inflammatory demyelinating sensory polyradiculopathy (CISP)
  • Uremia
  • Hypocalcemia
  • Copper deficiency
  • Heavy metal poisoning
  • Radiation
  • Hexane exposure
  • Ciguatera or saxitoxin poisoning
  • HIV neuropathy
  • Leprosy
  • Herpes simplex infection
  • Neurosyphilis
  • Herpes zoster infection (shingles)
  • Lyme disease
  • Functional neurologic and somatic symptom disorders
  • Inborn errors of metabolism
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Churg-Strauss syndrome
  • Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
  • Polyarteritis nodosa
  • Microscopic polyangiitis
  • Sjogren syndrome
  • Sarcoidosis
  • Monoclonal protein production
  • Focal seizures
  • Paraneoplastic sensory neuropathy or ganglionopathy
  • Intravascular lymphoma
  • Neuro-Behcet disease
  • Wartenberg migrant sensory neuritis
  • Numb chin syndrome
  • Peripheral neuropathy after bariatric surgery
  • Notalgia paresthetica
  • Neuromyelitis optica spectrum disorder (Devic disease)
  • Anti-myelin-associated glycoproteins (MAG) peripheral neuropathy
  • Hypertriglyceridemia
  • Human T-lymphotropic virus (HTLV)
Full details

Contributors

Authors

Nigel Ashworth, MBChB, MSc, FRCP(Can)

Professor

Division of Physical Medicine & Rehabilitation

Faculty of Medicine & Dentistry

University of Alberta

Edmonton

Canada

Disclosures

NA declares that he has no competing interests.

Acknowledgements

Dr Nigel Ashworth would like to gratefully acknowledge the late Dr Caroline M. Klein for her contribution to this topic.

Disclosures

CMK authored a number of references cited in this topic.

Peer reviewers

Richard W. Orrell, BSc, MD, FRCP

Senior Lecturer and Consultant Neurologist

Department of Clinical Neuroscience

UCL Institute of Neurology

London

UK

Disclosures

RWO declares that he has no competing interests.

Brian Christopher Callaghan, MD, MS

Professor of Neurology

University of Michigan

Ann Arbor

MI

Disclosures

Research contracts from AAN and editorial support. Dynamed consultant.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

England JD, Gronseth GS, Franklin G, et al. Practice parameter: evaluation of distal symmetric polyneuropathy: role of laboratory and genetic testing (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. 2009 Jan 13;72(2):185-92.Full text  Abstract

Jacoby N, Anziska Y. A practical approach to diagnosing peripheral neuropathies. Semin Neurol. 2025 Feb;45(1):4-12.Full text  Abstract

England JD, Franklin G, Gjorvad G, et al. Quality improvement in neurology: distal symmetric polyneuropathy quality measures. Neurology. 2014 May 13;82(19):1745-8.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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