Lupus

Wednesday, November 9, 2011

Paresthesia

 Having lupus, we all get strange symptoms, pains, aches, etc., so we are pretty much used to new developments.  Of course, not that it is ever welcomed.  I have been getting the numbness and pins and needles feeling in my legs and feet from sitting on the ahhhhummm toilet.  It was of no concern to me for, everyone gets this from time to time and it is NO big deal.  It started happening every time and even just from brief seconds on the pot.  Then yesterday it happened, something to add to my never ending list of symptoms/complaints, paresthesia.  What is that you ask, well it is the feeling of pins and needles in your body parts.  I got up after only a couple of minutes and I could not get the feeling to stop.  It is VERY annoying when it lasts a day instead of a few seconds.  I still have some strange numbness, and tingly sensations, on top of the pain.  This is in my feet and legs, both, because with lupus everything usually happen on both sides, at the same time.  So now I have some new issue maybe nothing, it may just go away never to return or it maybe a bit of a problem.  I do not want to call my rheumy, I do not want to know what kind of inflammation I have or if it is bad, I don't want to make an appointment, I want to ignore it and hope it will go away.  So the last option is what I will practice for today.  Here is some more information detailing paresthesia from two websites. 

http://www.rightdiagnosis.com/symptoms/breast_tingling_paresthesias/book-causes-14a.htm

http://en.wikipedia.org/wiki/Paresthesia

Paresthesia

Paresthesia is an abnormal sensation or combination of sensations — commonly described as numbness, prickling, or tingling — felt along peripheral nerve pathways; these sensations generally aren’t painful. Unpleasant or painful sensations, on the other hand, are termed dysesthesia. 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 from a particular drug. It may reflect 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

First, explore the paresthesia. When did the abnormal sensations begin? Have the patient describe their character and distribution. Also, ask about associated signs and symptoms, such as sensory loss and paresis or paralysis. Next, take a medical history, including neurologic, cardiovascular, metabolic, renal, and chronic inflammatory disorders, such as arthritis or lupus. Has the patient recently sustained a traumatic injury or had surgery or an invasive procedure that may have damaged peripheral nerves?

Physical assessment

Focus the physical examination on the patient’s neurologic status. Assess his level of consciousness (LOC) and cranial nerve function. Test muscle strength and deep tendon reflexes (DTRs) in limbs affected by paresthesia. Systematically evaluate light touch, pain, temperature, vibration, and position sensation. Also, note skin color and temperature, and palpate pulses.

Medical causes

Arterial occlusion (acute)

With acute arterial occlusion, sudden paresthesia and coldness may develop in one or both legs with a saddle embolus. Paresis, intermittent claudication, and aching pain at rest are also characteristic. The extremity becomes mottled with a line of temperature and color demarcation at the level of occlusion. Pulses are absent below the occlusion, and capillary refill time is increased.

Arteriosclerosis obliterans

Arteriosclerosis obliterans produces paresthesia, intermittent claudication (most common symptom), diminished or absent popliteal and pedal pulses, pallor, paresis, and coldness in the affected leg.

Arthritis

Rheumatoid or osteoarthritic changes in the cervical spine may cause paresthesia in the neck, shoulders, and arms. The lumbar spine occasionally is affected, causing paresthesia in one or both legs and feet.

Brain tumor

Tumors affecting the sensory cortex in the parietal lobe may cause progressive contralateral paresthesia accompanied by agnosia, apraxia, agraphia, homonymous hemianopsia, and loss of proprioception.

Buerger’s disease

With Buerger’s disease, exposure to cold makes the feet cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication, which is aggravated by exercise and relieved by rest, is also common. Other findings include weak peripheral pulses, migratory superficial thrombophlebitis and, later, ulceration, muscle atrophy, and gangrene.

Diabetes mellitus

Diabetic neuropathy can cause paresthesia with a burning sensation in the hands and legs.Other findings include insidious, permanent anosmia; fatigue; polyuria; polydipsia; weight loss; and polyphagia.

Guillain-Barré syndrome

With Guillain-Barré syndrome, transient paresthesia may precede muscle weakness, which usually begins in the legs and ascends to the arms and facial nerves. Weakness may progress to total paralysis. Other findings include dysarthria, dysphagia, nasal speech, orthostatic hypotension, bladder and bowel incontinence, diaphoresis, tachycardia and, possibly, signs of life-threatening respiratory muscle paralysis.

Head trauma

Unilateral or bilateral paresthesia may occur when head trauma causes a concussion or contusion; however, sensory loss is more common. Other findings include variable paresis or paralysis, decreased LOC, headache, blurred or double vision, nausea and vomiting, dizziness, and seizures.

Heavy metal or solvent poisoning

Exposure to industrial or household products containing lead, mercury, thallium, or organophosphates may cause paresthesia of acute or gradual onset. Mental status changes, tremors, weakness, seizures, and GI distress are also common.

Herniated disk

Herniation of a lumbar or cervical disk may cause acute or gradual onset of paresthesia along the distribution pathways of affected spinal nerves. Other neuromuscular effects include severe pain, muscle spasms, and weakness that may progress to atrophy unless herniation is relieved.

Herpes zoster

An early symptom of herpes zoster, paresthesia occurs in the dermatome supplied by the affected spinal nerve. Within several days, this dermatome is marked by a pruritic, erythematous, vesicular rash associated with sharp, shooting, or burning pain.

Hyperventilation syndrome

Usually triggered by acute anxiety, hyperventilation syndrome may produce transient paresthesia in the hands, feet, and perioral area, accompanied by agitation, vertigo, syncope, pallor, muscle twitching and weakness, carpopedal spasm, and cardiac arrhythmias.

Hypocalcemia

Asymmetrical paresthesia usually occurs in the fingers, toes, and circumoral area early in hypocalcemia. Other signs and symptoms are muscle weakness, twitching, or cramps; palpitations; hyperactive DTRs; carpopedal spasm; and positive Chvostek’s and Trousseau’s signs.

Migraine headache

Paresthesia in the hands, face, and perioral area may herald an impending migraine headache. Other prodromal symptoms include scotomas, hemiparesis, confusion, dizziness, and photophobia. These effects may persist during the characteristic throbbing headache and continue after it subsides.

Multiple sclerosis

With multiple sclerosis, demyelination of the sensory cortex or spinothalamic tract may produce paresthesia — typically one of the earliest symptoms. Like other effects of multiple sclerosis, paresthesia commonly waxes and wanes until the later stages, when it may become permanent. Associated findings include muscle weakness, spasticity, and hyperreflexia.

Peripheral nerve trauma

Injury to any major peripheral nerve can cause paresthesia — often dysesthesia — in the area supplied by that nerve. Paresthesia begins shortly after trauma and may be permanent. Other findings are flaccid paralysis or paresis, hyporeflexia, and variable sensory loss.

Peripheral neuropathy

Peripheral neuropathy can cause progressive paresthesia in all extremities. The patient also commonly displays muscle weakness, which may lead to flaccid paralysis and atrophy; loss of vibration sensation; diminished or absent DTRs; euralgia; and cutaneous changes, such as glossy, red skin and anhidrosis.

Rabies

Paresthesia, coldness, and itching at the site of an animal bite herald the prodromal stage of rabies. Other prodromal signs and symptoms are fever, headache, photophobia, hyperesthesia, tachycardia, shallow respirations, and excessive salivation, lacrimation, and perspiration.

Raynaud’s disease

With Raynaud’s disease, exposure to cold or stress makes the fingers turn pale, cold, and cyanotic; with rewarming, they become red, throbbing, aching, swollen, and paresthetic. Ulceration may occur in chronic cases.

Seizure disorders

Seizures originating in the parietal lobe usually cause paresthesia of the lips, fingers, and toes. The paresthesia may act as auras that precede tonic-clonic seizures. After the seizure, the patient may complain of headache, fatigue, muscle soreness, and arm and leg weakness.

Spinal cord injury

Paresthesia may occur in partial spinal cord transection, after spinal shock resolves. It may be unilateral or bilateral, occurring at or below the level of the lesion. Associated sensory and motor loss is variable. (See Understanding spinal cord syndromes, page 495.) Spinal cord disorders may be associated with paresthesia on head flexion (Lhermitte’s sign).

Spinal cord tumors

Paresthesia, paresis, pain, and sensory loss along nerve pathways served by the affected cord segment result from spinal cord tumors. Eventually, paresis may cause spastic paralysis with hyperactive DTRs (unless the tumor is in the cauda equina, which produces hyporeflexia) and, possibly, bladder and bowel incontinence.

Stroke

Although contralateral paresthesia may occur with stroke, sensory loss is more common. Associated features vary with the artery affected and may include contralateral hemiplegia, decreased LOC, and homonymous hemianopsia.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) may cause paresthesia, but its primary signs and symptoms include nondeforming arthritis (usually of hands, feet, and large joints), photosensitivity, and a “butterfly rash” that appears across the nose and cheeks.

Thoracic outlet syndrome

Paresthesia occurs suddenly in this syndrome when the affected arm is raised and abducted. The arm also becomes pale and cool with diminished pulses. Unequal blood pressure between arms may be noted.

Transient ischemic attack

Paresthesia typically occurs abruptly with a transient ischemic attack (TIA) and is limited to one arm or another isolated part of the body. It usually lasts about 10 minutes and is accompanied by paralysis or paresis. Associated findings include decreased LOC, dizziness, unilateral vision loss, nystagmus, aphasia, dysarthria, tinnitus, facial weakness, dysphagia, and ataxic gait.

Vitamin B deficiency

Chronic thiamine or vitamin B12 deficiency may cause paresthesia and weakness in the arms and legs. Burning leg pain, hypoactive DTRs, and variable sensory loss are common in thiamine deficiency; vitamin B12 deficiency also produces mental status changes and impaired vision.

Other causes

Drugs

Phenytoin, chemotherapeutic agents (such as vincristine, vinblastine, and procarbazine), d-penicillamine, isoniazid, nitrofurantoin, chloroquine, and parenteral gold therapy may produce transient paresthesia that disappears when the drug is discontinued.

Radiation therapy

Long-term radiation therapy eventually may cause peripheral nerve damage, resulting in paresthesia.

Special considerations

Continue to monitor the patient’s neurologic status. Help the patient perform daily activities as necessary. If he has sensory deficits, protect him from injury, heat, or pressure.

Chronic paresthesia indicates a problem with the functioning of neurons.
In older individuals, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease, also referred to by physicians as PVD or PAD), most often caused by atherosclerosis, the build up of plaque within artery walls, over decades, with eventual plaque ruptures, internal clots over the ruptures and subsequent clot healing but leaving behind narrowing of the artery openings or closure, both locally and in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency and malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism.
Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress,[citation needed] bone disease, poor posture, unsafe heavy-lifting practices or physical trauma such as whiplash. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time.
Another cause of paresthesia, however, may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury or infection such as frostbite or Lyme disease, or which may be indicative of a current neurological disorder. Benzodiazepine withdrawal may also cause it as the drug removal leaves the GABA receptors stripped bare and possibly malformed. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack, or autoimmune diseases like multiple sclerosis or lupus erythematosus.
The herpes zoster virus (shingles) can attack nerves causing numbness instead of pain commonly associated with shingles. A diagnostic evaluation by a medical doctor is necessary to rule these out.[clarification needed]
Demyelinating diseases may also cause cross-talk between adjacent axons and lead to parasthesia. During impulse conduction some aberrant current that escaped a demyelinated axon can circulate in the exterior and depolarize an adjacent demyelinated, hyperexcitable axon. This can generate impulses conducted in both directions along this axon since no part of the axon is in a refractory state. This becomes very serious in conditions such as multiple sclerosis and Guillain–Barré syndrome.

[edit] Acroparesthesia

Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis.[2]

Treatment

Medications offered can include the immunosuppressant prednisone, intravenous gamma globulin (IVIG), anticonvulsants such as gabapentin or Gabitril and antiviral medication, among others, according to the underlying cause.
In addition to treatment of the underlying disorder, palliative care can include the use of topical numbing creams, such as lidocaine or prilocaine. Care must be take to apply only the necessary amount, as excess can contribute to the condition. Otherwise, these products offer extremely effective, but short-lasting, relief from the condition.
In some cases, rocking the head from side to side will painlessly remove the "pins and needles" sensation in less than a minute. A tingly hand or arm is often the result of compression in the bundle of nerves in the neck. Loosening the neck muscles releases the pressure. Compressed nerves lower in the body govern the feet, and standing up and walking around will typically relieve the sensation. An arm that has "fallen asleep" may also be "awoken" more quickly by clenching and unclenching the fist several times; the muscle movement increases blood flow and helps the limb return to normal. However, in some cases, this clenching action simply exacerbates the discomfort. More rapid relief can sometimes be obtained by gently and systematically massaging the affected area of the body.
Paresthesia caused by shingles is treated with appropriate antiviral medication.

5 comments:

  1. I have this problem too, particularly in my feet, in fact my hands and feet were one of the first symptoms a few years ago that I noticed first. Even with the meds, my feet still ache, contort into weird positions and just down right hurt. Unfortunately, it now has become part of my everyday life and I guess one of the strange symptoms of lupus...I have even had to buy special arthritis approved devices to help me open bottles of water, cans of food etc., so I can open them because my hands almost always hurt. I expected this may have been part of my life in my later years, but not at my age...it's hard work and depressing dealing with this disease and usually exhausting just doing "normal" things...I am sure many of you can relate. I will be trying antibiotic treatment as it completely cured my childhood friend of scleroderma and she has been in remission for ten years....then chinese acupuncture for pain mgmt....I will not give up!! Don't any of you either, there is always hope!!!

    ReplyDelete
  2. Lupysue, I agree don't give up there is always hope, I am so sorry you are suffering, but we are all in this together. xoxo

    ReplyDelete
  3. I have this too, they seem to come and go along with flares. Strange.

    ReplyDelete
  4. I'd had it for years, and it drove me crazy. Finally found a rheumy who could add 2+2 and am now on Gabapentin 800mg 3x a day, and it has improved immensely my Dr said it was Peripheral neuropathy , which was caused from the SLE destroying my nerve endings. We approximate I've had SLE for a LONG time, since at 48 I have had 16 sugeries in the past that can now be attributed to SLE. On anti-maleria meds now, and a pretty strong anti-biotic to get rid of pleurisy and pancreatitus, both due to SLE. it's amazing how my insides are so destroyed, but everyone thinks I am "faking" Don't we just love the misunderstanding?

    ReplyDelete
  5. Soph, mine come and go too,xo

    Teresa, I am so sorry you are having so many serious problems due to lupus. It makes me so sad how so many have to suffer and not get the support that they would get if they had cancer or another respected disease. I have no clue why some people refuse to believe that lupus is a serious, debilitating, potentially fatal disease. My family is generally supportive my husband and children are, my mother tries but sometimes says things that make me think she just doesn't get it. But I think most people that don't have lupus just don't get it, just some try to be supportive and understand and those are the people that matter. It is so hard in so many ways. Sending you love and prayers. xo

    ReplyDelete