Assessment of paraesthesias

paraesthesias in first three digits of affected hand; grip weakness; pain in wrist or hand possibly extending into forearm, elbow, or shoulder; symptoms worse at night (awakening patient from sleep) and exacerbated by prolonged wrist extension such as driving, typing on a keyboard, or reading a newspaper

weakness in median-innervated hand muscles; decreased pinprick sensation on palmar aspect of first three digits; positive carpal tunnel compression tests: paraesthesias elicited by Tinel's manoeuvre (lightly percussing the nerve), Phalen's manoeuvre (maximum passive flexion of the wrist for 1 minute), or reverse Phalen's manoeuvre (hand in a fist with maximum wrist extension and pressure applied to carpal tunnel for 1 minute)

paraesthesias involving fourth and fifth digits of affected hand; weakness in hand grip; possible elbow pain; history of prolonged or repetitive flexion of elbow or leaning on elbow

weakness in interossei; weak flexion with wrist in ulnar deviation; weak flexion of distal joint of fourth and fifth digits; loss or relative reduction of pinprick sensation on palmar and dorsal aspect of fourth and fifth digits of affected hand; palpation of the ulnar nerve in olecranon groove elicits paraesthesias

history of weight loss; trauma or surgery involving lateral aspect of affected knee; history of repetitive crossing of knees or prolonged kneeling, crouching, or squatting prior to onset of symptoms; pain at knee; paraesthesias in lateral leg and dorsal foot; foot drop

weakness in ankle dorsiflexion and toe extension, eversion of the ankle, decreased pinprick sensation on lateral leg and dorsal foot and ankle, palpation of the fibular (peroneal) nerve at the fibular head just distal to the knee joint elicits paraesthesias

acute or subacute onset of burning paraesthesias in the anterolateral thigh region with increased sensitivity to touch or pressure

allodynia or hypersensitivity to touch, with sensory loss, in distribution of the lateral femoral cutaneous nerve of the thigh, either unilaterally or bilaterally, preserved quadriceps deep tendon reflex, no motor weakness

neck pain with radiation into upper extremity, possibly in a dermatomal pattern; paraesthesias in affected arm and/or hand; muscle weakness in corresponding myotomes

pain with palpation of the spine or range-of-motion testing, reduced pinprick sensation in dermatomal distribution, muscle weakness in myotomal distribution, loss or reduction of deep tendon reflexes in affected limb compared with the unaffected side

pain, burning, numbness on trunk or chest wall in a dermatomal pattern, muscle weakness in corresponding myotomes

pain with palpation of the spine or range-of-motion testing, reduced pinprick sensation in dermatomal distribution, muscle weakness in myotomal distribution

low back pain with radiation into the leg in a dermatomal pattern, paraesthesias in dermatomal pattern, muscle weakness in corresponding myotomes

pain with palpation of the spine or range-of-motion testing, reduced pinprick sensation in dermatomal distribution, muscle weakness in myotomal distribution, loss or reduction of deep tendon reflexes in affected limb compared with the unaffected side, hip range-of-motion testing and straight leg raising reproduces symptoms radiating from the lower back into the leg

back pain; bowel and bladder incontinence; difficulty walking due to spasticity; muscle weakness in the lower extremities; paraesthesias in the extremities; intermittent paraesthesias in the body associated with neck flexion (Lhermitte’s sign)

brisk deep tendon reflexes; ankle clonus; upgoing toes to plantar stimulation; sensory loss and motor weakness caudal to the spinal level affected

acute onset of paraesthesias, weakness, incoordination, visual changes developing at different times that may or may not resolve after being present for a few days to months; bowel and bladder incontinence, bladder retention, or bladder spasms. Patches of odd sensation such as wetness or tingling may occur, and band-like or hemiband-like sensations are pathognomonic for spinal cord lesions.

loss of sensation in the extremities or face, pupillary abnormalities and visual loss, muscle weakness and spasticity, incoordination, abnormal gait

usually insidious onset of distally and symmetrically distributed symptoms of paraesthesias (usually tingling paraesthesias with or without associated asleep- or dead-type numbness in the same areas) and usually later muscle weakness; progressive symptoms from onset, may be intermittently present initially, then become more constant, and begin in the toes and extend proximally in both legs to the level of the knees, at which point the distal fingertips of both hands typically become involved; if small sensory nerve fibres are affected, burning pains and allodynia (painful sensations elicited by normally non-noxious stimuli, such as light touch) are usually reported by the patient

initially distally reduced or loss of sensation (light touch, pinprick, temperature, vibratory, joint position sense), with a gradient of return to normal sensation moving from distal to proximal regions of the lower limbs; if primarily small diameter sensory nerve fibres involved, may be dissociation between abnormal findings when testing for spinothalamic (pinprick, temperature) and dorsal column (vibratory, joint position sense) pathways, with the former showing reduced or absent sensation distally in the limbs; if only small diameter, unmyelinated sensory nerve fibres involved, the neurological exam may be normal in early stages (or have abnormal findings only in terms of reduced or absent pinprick and/or temperature sensation), with more findings developing over time as the polyneuropathy progressively worsens and larger diameter sensory nerves become affected by the disease process; sensory ataxia and positive Romberg sign may be present if there is significant impairment of joint position sensation; distal motor weakness in the same distribution as the sensory loss, when present; reduced or absent deep tendon reflexes, worse in the lower limbs, and symmetric in distribution

history of diabetes mellitus; history of other end-organ disease from diabetes mellitus, such as retinopathy or nephropathy; distal paraesthesias or burning pains; painless and occult injuries to the feet due to lack of protective sensation; possible muscle weakness or abnormal gait

distal loss of sensation affecting lower more than upper extremities, reduced deep tendon reflexes (especially Achilles reflexes), possible muscle weakness and atrophy

cold intolerance, weight gain, fatigue, brittle hair or nails; distal extremity paraesthesias, possible motor weakness

loss of sensation in the distal extremities or in the distribution of individual peripheral nerves, such as median nerve in the hand; possible muscle weakness in the distal extremities and decreased or delayed deep tendon reflexes

vomiting, encephalopathy, burning feet, shooting pains, calf cramps; heart failure symptoms in infants

encephalopathy; decreased deep tendon reflexes, distal muscle weakness affecting lower more than upper extremities, hoarseness from laryngeal nerve palsy

paraesthesias in the extremities, gait unsteadiness, seborrhoeic dermatitis, atrophic glossitis with ulceration, angular cheilitis

loss of sensation in the distal lower extremities, distribution of sensory loss may be patchy, decreased deep tendon reflexes

history of peptic ulcer disease or other upper gastrointestinal condition or surgery that may reduce absorption of vitamin B12, ataxia, paraesthesias may be transient and migratory

loss of deep tendon reflexes, decreased vibratory and joint position sensation initially with paraesthesias, may have gait ataxia; increased or preserved reflexes with severe deficiency

history of malabsorption due to cirrhosis, cystic fibrosis, coeliac disease, Crohn's disease, cholestatic liver disease; gait unsteadiness and paraesthesias in the lower extremities

gait ataxia; absent or decreased deep tendon reflexes; loss of proprioceptive and vibratory sensation

history of exposure to chemotherapy agents (cisplatin, vincristine, cytosine arabinoside, thalidomide, paclitaxel), antibiotics (metronidazole, nitrofurantoin), antiretroviral agents (zidovudine, stavudine, lamivudine), antiepileptics (phenytoin), or vitamin B6 overdose; slowly progressive distal paraesthesias

distal loss of sensation in the extremities; possible muscle weakness

history of alcohol misuse, gait instability, paraesthesias in the distal lower extremities progressing proximally, paraesthesias of the fingers and hands appear once symptoms extend above ankle level

loss of sensation and deep tendon reflexes in the lower extremities, sensory ataxia, positive Romberg's sign; signs of alcoholic liver disease: ascites, splenomegaly, cutaneous telangiectasias, palmar erythema, finger clubbing, Dupuytren's contractures

sudden onset of numbness in the face or extremities (more likely to be loss of sensation reported by the patient than pain or tingling paraesthesias), may or may not be unilateral and may or may not involve motor weakness, slurred speech, change in vision; history of risk factors for stroke, including tobacco smoking, diabetes mellitus, hypertension, history of prior stroke

loss of sensation in the face or the extremities either on the same side of the body (hemisensory) or on opposite sides for the face and body, depending on the location of the infarct

acute onset of paraesthesias spreading over several minutes in association with severe, throbbing, usually unilateral headache; may have nausea and vomiting, photophobia, phonophobia; sensory symptoms may start in the hand and then progress to involve ipsilateral arm, face, and tongue; sensory symptoms typically last <1 hour from the onset of the headache

may be normal as paraesthesias may be transient, may demonstrate sensory loss in face or extremities if examined during the episode

history of smoking, diabetes mellitus, hyperlipidaemia, coronary artery disease or cerebrovascular disease, claudication, pain and paraesthesias worse in one leg

reduced or absent peripheral pulses, pallor and cold of affected limb, non-healing leg wounds or ulcers, muscle atrophy, loss of hair over the dorsum of the foot, shiny or scaly skin, thickened toe nails

hyperventilation, associated symptoms of anxiety or panic including overwhelming sense of impending doom, chest pain, palpitations and shortness of breath, perioral and bilateral paraesthesias in hands and feet with associated carpopedal spasm

may be normal; patient visibly hyperventilating, carpopedal spasm

abnormal or clumsy gait due to foot drop; toe-walking as a child; paraesthesias are minimal

length-dependent, symmetric, 'glove and stocking' distribution of sensory and motor abnormalities, distal muscle atrophy; inverted 'champagne bottle' legs, pes cavus, and hammer-toe deformities

positive family history, painless injuries to the extremities, severe burning pain in the feet, possible dysautonomia

length-dependent sensory greater than motor peripheral neuropathy, dry skin, pes cavus, and hammer-toe deformities; may have orthostatic hypotension

multiple entrapment neuropathies in the extremities in the setting of minimal compression; positional paraesthesias in the extremities

pes cavus and hammer-toe deformities; focal motor weakness and numbness in distribution of individual peripheral nerves; positive Tinel's or Phalen's sign

history of injury, acute onset of unilateral shoulder or arm pain (if inflammatory) followed by numbness and weakness in the affected arm after the pain has resolved, shortness of breath due to diaphragmatic involvement if cervical roots involved

loss of sensation and weakness in affected limb involving more than a single peripheral nerve territory; possible loss of reflexes

history of injury, pelvic mass, surgical, or vascular procedure, painless onset of numbness and paraesthesias and weakness in affected leg

loss of sensation and weakness in affected limb involving more than a single peripheral nerve territory; possible loss of reflexes

pain and paraesthesias in the medial aspect and sole of the foot, medial ankle pain, foot weakness

loss of sensation on the sole of the affected foot, weakness with toe flexion, compression of the tibial nerve in the tarsal tunnel just proximal to the medial malleolus reproduces paraesthesias, normal Achilles deep tendon reflex

acute or subacute onset of hemifacial pain and paraesthesias

loss of sensation in the hemiface or in the distribution of individual branches of the trigeminal nerve; corneal reflex absent or reduced on the affected side

acute or subacute onset of headache, cognitive changes, paraesthesias in the extremities, weakness, gait difficulty, fever, meningismus, typically occurs 1 to 2 weeks after a viral illness or vaccination

loss of sensation in the extremities; mental status changes; may have muscle weakness and spasticity in the extremities

initially acute onset of paraesthesias in the toes, with rapidly ascending paraesthesias and motor weakness; may involve respiratory and bulbar muscles and lead to acute respiratory failure; progression may proceed over hours to a couple of days; symptoms may develop after recent (within 2 weeks) upper respiratory or gastrointestinal viral infection or vaccination

absence of deep tendon reflexes, flaccid paralysis, and loss of sensation involving proximal and distal limb segments (upper and lower extremities)

progressive numbness and weakness of the extremities with symmetric involvement

proximal and distal symmetric extremity muscle weakness, loss of sensation distally in the extremities, loss of deep tendon reflexes

progressive paraesthesias and gait instability

loss of sensation in the extremities and loss of deep tendon reflexes, motor examination is relatively preserved, sensory gait ataxia

history of renal failure, paraesthesias of distal extremities progressing proximally and followed by motor weakness; associated vomiting, fatigue, anorexia, weight loss, muscle cramps, pruritus, mental status changes, visual disturbances, increased thirst; possible superimposed compression neuropathy

impaired vibratory sensation, absent deep tendon reflexes

history of thyroid surgery or hypoparathyroidism, lethargy, muscle cramps, twitches, spasms, or tetany

positive Chvostek's or Trousseau's sign

history of zinc exposure or toxicity, paraesthesias, abnormal gait

spasticity in the lower extremities with increased or preserved reflexes, loss of vibratory and joint position sense

history of heavy metal exposure (use of treated lumber, consumption of well water, use of fertilisers or insecticides containing arsenic), acute exposure may have gastrointestinal symptoms including nausea and vomiting, abdominal pain and diarrhoea; paraesthesias and weakness in the distal extremities that progress proximally; mercury poisoning: patients also have circumoral paraesthesias with slurred speech, tremors, and psychiatric manifestations; lead toxicity may cause lead encephalopathy

distal sensory loss and weakness in the distal extremities, loss of deep tendon reflexes, Mee lines on fingernail beds, hyperkeratosis of the skin of palms and soles, alopecia in thallium toxicity

history of radiotherapy to axilla, groin, or pelvis; brachial plexopathy: acute onset of unilateral shoulder and/or arm pain (if inflammatory), followed by numbness and weakness in the affected arm after the pain has resolved, shortness of breath due to diaphragmatic involvement if cervical roots involved; lumbosacral plexopathy: history of pelvic mass, surgical or vascular procedure, painless onset of numbness and paraesthesias, and weakness in affected leg

loss of sensation and weakness in affected limb involving more than a single peripheral nerve territory; possible loss of reflexes

history of glue-sniffing behaviour or industrial exposure, paraesthesias in the distal lower extremities progressing proximally, paraesthesias of the fingers and hands appear once symptoms extend above ankle level

loss of sensation and deep tendon reflexes in the lower extremities, sensory ataxia, positive Romberg's sign

history of ingestion of fish that are known to contain neurotoxins, acute or subacute onset of distal paraesthesias and circumoral paraesthesias and paralysis, acute gastrointestinal symptoms within hours after ingestion, myalgias

loss of sensation in the extremities, loss of deep tendon reflexes, motor weakness, or paralysis depending on the severity of the poisoning

history of long-standing HIV infection, distal extremity sensory symptoms (paraesthesias) and motor weakness

distal sensory loss in the extremities with or without muscle weakness

residency or travel to endemic area; close contact with infected person; skin macules, papules, or nodules; distal sensory followed by motor loss

distal sensory changes and later motor weakness; may be confined to distribution of individual peripheral nerves

dysuria, prodrome of localised tingling sensation prior to the appearance of genital or oral ulcers

fever, lymphadenopathy, normal neurological examination

history of syphilis, progressive gait unsteadiness, lancinating pains, and paraesthesias in the extremities

tabes dorsalis: loss of proprioceptive and vibratory sensation in the distal extremities, gait ataxia, reduced deep tendon reflexes, Argyll-Robertson pupils; polyradiculopathy: sensory, and loss and weakness in the distal extremities

burning or stabbing followed by a vesicular rash in the affected dermatome

erythematous maculopapular rash, followed by the appearance of clear vesicles, in a dermatomal distribution; corneal ulceration may be present if the trigeminal nerve is affected

history of tick bite with erythema migrans; residence in or travel to endemic area, painful paraesthesias in upper more than lower extremities; possible associated arthritis, stiff neck and photophobia (due to meningitis), cranial neuropathies, fatigue, fevers

distal sensory loss and motor weakness, lymphadenopathy

history of psychological or physical trauma; paraesthesias associated with other neurological and psychiatric symptoms

normal

positive family history; painful paraesthesias in the extremities; associated sphincter dysfunction, gait abnormalities, dementia, and other specific features depending on the cause

sensory loss in the distal extremities, and other specific features depending on the cause

acute onset of pain, then paraesthesias and weakness in the distribution of single or multiple peripheral nerves (mononeuritis multiplex); associated arthralgias

joint deformities, loss of deep tendon reflexes, loss of sensation and weakness and muscle atrophy in distribution of individual peripheral nerves or in distal extremities; joint deformities and tenderness to palpation

arthralgias; photosensitive malar (butterfly), generalised, or discoid rash; fatigue, weight loss, painful sensory symptoms, or paraesthesias or sensory loss

joint tenderness to palpation and joint swelling in multiple joints; distal sensory and motor deficits on neurological examination; lymphadenopathy; alopecia, oral ulcers, lymphadenopathy

fever, weight loss, fatigue, allergic rhinitis, asthma, cardiovascular disease; numbness or weakness in the distal extremities (polyneuropathy), or in individual nerve distributions (mononeuritis multiplex)

palpable purpura, loss of sensation or weakness in distal extremities or in individual nerve distributions

sinus disease; oral or nasal ulcers; parenchymal nodules in lung or upper respiratory tract; polyarthralgias; myalgias; purpura; acute onset of pain; paraesthesias; motor weakness in distribution of individual peripheral nerves (mononeuritis multiplex)

loss of sensation or weakness in distribution of individual peripheral nerves

pain, numbness, and paraesthesias, and possibly weakness, in the distribution of single or multiple peripheral nerves (mononeuritis multiplex)

loss of sensation and muscle weakness in distribution of single or multiple peripheral nerves

acute onset of pain, numbness, and weakness in the distribution of single or multiple peripheral nerves (mononeuritis multiplex)

loss of sensation and weakness in distribution of single or multiple peripheral nerves

dry eyes (xerophthalmia) and dry mouth (xerostomia), patchy burning pains, paraesthesias that may be migratory and involve cranial nerve distributions, autonomic symptoms such as orthostatic intolerance and sweating abnormalities, associated arthralgias, other rheumatological symptoms

tonic pupils, severe dry eye and dry mouth, patchy sensory loss greater than motor involvement; may have excessive (hyperhidrosis) or decreased (hypohidrosis or anhidrosis) sweating, orthostatic hypotension, or tachycardia

pain, numbness, and weakness of the extremities; history of shortness of breath or pulmonary symptoms; skin lesions; ocular problems

decreased or absent sensation in the distal extremities, possibly also in a dermatomal pattern also in the trunk or extremities (radiculopathy); muscle weakness in distal extremities; loss of or diminished deep tendon reflexes; may have cranial neuropathies. Certain clinical features are highly specific for the disease and are considered diagnostic, including Löfgren's syndrome, lupus pernio, and Heerfordt's syndrome.

cranial neuropathies, distal paraesthesias, and motor weakness; may also have numbness and weakness in the territories of multiple individual peripheral nerves; cryoglobulinaemia: history of hepatitis C; episodic purpura in the lower extremities or trunk

distal symmetric sensory loss and motor weakness, decreased sensation and weakness in the distribution of multiple peripheral and/or cranial nerves, decrease or loss of deep tendon reflexes, purpuric skin lesions

stereotyped pattern and distribution of sensory symptoms evolving over a few seconds; automatisms or altered level of consciousness or responsiveness indicates complex partial seizure with focal onset involving somatosensory cortex

normal; may be abnormal, with focal findings, if seizures are due to intracranial mass lesion

ataxia, paraesthesias, and sensory loss; history of cancer or cancer risk factors, weight loss, or specific symptoms of underlying cancer

severe sensory loss, ataxia; may have cerebellar signs, loss of deep tendon reflexes, or pseudoathetosis; specific signs of underlying cancer

paraesthesias, muscle weakness, speech difficulties (production and understanding), seizures, transient visual loss, vertigo, and impaired cognitive function

sensory and motor neuropathies, hemiparesis, meningoradiculitis, dysarthria, aphasia, impaired cognitive function

rarely presents with paraesthesias and weakness in the extremities; cerebrospinal fluid involvement leads to variable symptoms including headaches, mental status changes, hemiparesis, dizziness, loss of balance, or coma

weakness and sensory deficits in extremities

sudden-onset painful paraesthesias in distribution of one or multiple cutaneous or sensory nerves (most commonly peripheral limb nerves, but also trigeminal nerve and truncal branches), either sequentially or simultaneously; paraesthesia can be preceded by painful sensations (stabbing, burning, tingling) in the same area; stretching of affected nerve (e.g., by kneeling) may precipitate symptoms​

sensory deficits in distribution of affected nerve; normal motor function

unilateral paraesthesias or anaesthesia of chin; possible history of dental or oral surgery; may be initial manifestation of multiple sclerosis or occult malignancy​

unilateral sensory deficit on chin

history of bariatric surgery within prior 12-24 month period, especially in association with rapid loss of a large amount of body weight; symmetric sensory symptoms of asleep- or dead-type numbness and paraesthesias in the hands and feet, occasionally with some muscle weakness in these same regions; insidious more often than acute or sub-acute onset of symptoms; aching, sharp, or burning pains in hands and feet

loss or reduction of sensation (light touch, pinprick, temperature, vibratory, joint position sensations) in distal lower more than upper extremities, in a symmetric pattern; some muscle weakness possible in the distal lower extremities, including foot drop; reduced or absent deep tendon reflexes in the lower more than the upper extremities, also symmetric in distribution; may have sensory ataxia and positive Romberg sign if sensory loss is severe and involving the large myelinated nerve fibres (dorsal column pathway); may have small diameter, unmyelinated sensory nerve fibre impairment only, in which case the neurological exam may be normal or have abnormal findings only in terms of reduced or absent pinprick and/or temperature sensation in a distal pattern involving the hands and feet

itching or pruritus in a unilateral, dermatomal (T2-T6) distribution in the upper back, below the scapula; may also be accompanied by localised pain, tingling numbness, or increased sensitivity in the same area

skin changes resulting from persistent scratching of the affected area; may have decreased (or increased) light touch, temperature or pinprick sensation in the affected dermatomes posteriorly

acute often bilateral visual loss and eye pain (worse with movements of eye); may be nausea, vomiting and hiccups and/or leg and arm weakness, bowel and bladder dysfunction and sensory loss; typically follows a relapsing pattern over weeks or months

afferent pupillary defect, visual field loss and hyperaemia and swelling of the optic disc; sensory level, weakness in myotomal distributions, initial reduction in reflexes (due to spinal shock) then hyperreflexia

distal acquired demyelinating, symmetric neuropathy (DADS) with numbness and tingling in hands and feet with difficulty walking due to poor balance; muscle weakness in legs and hands, often with involuntary hand ‘shaking’ (tremor); most patients are male

sensory loss in hands and feet especially to vibration; ataxic gait and tremor in hands; reflexes usually reduced or absent

chronic pain, numbness, tingling in feet

decreased pin sensation in feet with normal vibration and normal strength; absent ankle reflexes

weakness, stiffness, and numbness in legs associated with urinary incontinence and often severe back pain

hyperreflexia with clonus and spasticity in the legs; numbness and weakness in legs