Numbness and tingling
Numbness and tingling (paresthesias) represent altered sensation that may indicate peripheral nerve, spinal cord, or central nervous system pathology.
Differential Diagnosis
Life-Threatening
- Stroke (acute unilateral numbness)
- Cauda equina syndrome (saddle anesthesia)
- Epidural abscess (spinal)
- Spinal cord compression
- Aortic dissection (limb malperfusion)
- Acute arterial ischemia
Peripheral Nervous System
- Carpal tunnel syndrome
- Peripheral neuropathy (diabetic, alcoholic, B12 deficiency)
- Radiculopathy (cervical or lumbar)
- Guillain-Barre syndrome
- Ulnar neuropathy
- Meralgia paresthetica
Central
Other
- Hyperventilation syndrome
- Hypocalcemia
- Hypokalemia
- Medication side effect
Evaluation
- Detailed neurologic exam: map the distribution (dermatomal, stocking-glove, unilateral)
- Acute unilateral numbness: emergent stroke workup (CT head, CTA, glucose)
- Saddle anesthesia + urinary retention: emergent MRI for cauda equina
- Progressive ascending weakness: consider Guillain-Barre syndrome
- Labs: glucose, BMP, B12, TSH as appropriate
Management
- Treat underlying cause
- Acute stroke: follow Stroke (main) protocol
- Cauda equina: emergent neurosurgical consultation
- Peripheral neuropathy: outpatient workup appropriate in most cases
Disposition
- Admit for acute stroke, cauda equina, cord compression, or Guillain-Barre
- Discharge with urgent follow-up for stable peripheral neuropathy
- Discharge with return precautions for isolated paresthesias with normal exam