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A Practical Diagnostic Approach. FROM: American Family Physician 1997 (Dec); 56 (9): 2253–2260. Paresthesias may be caused by central or peripheral nervous system abnormalities. Central nervous system-induced paresthesias are most commonly caused by state university ischemia, structural or compressive phenomena, infection, inflammation or degenerative conditions. Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions. Pathophysiology and Etiology. Radiculopathies caused by compression of cervical or lumbar nerve roots are common causes of paresthesias 8 ( Table 3 ). Causalgia is an intense, burning type of paresthesia caused by trauma to a nerve (e.g., the median, ulnar, posterior tibial or peroneal nerves). 9(p1161) Reflex sympathetic dystrophy is an unusual cause of paresthesias, pain and essays on broken families, autonomic dysfunction occurring after minor soft tissue injuries or fractures and usually affecting the distal extremities. 10 Toxic injury to nerves may be caused by cancer chemotherapy (e.g., cisplatin [Platinol], vincristin [Oncovin, Vincasar]), heavy metals (e.g., lead, mercury, arsenic), medications (e.g., isoniazid (Laniazid), nitrofurantoin (Furadantin, Macrodantin, Macrobid), gold, hydralazine (Apresoline), industrial exposures (e.g., acrylamide, carbon disulfide, hexacarbons, trichloroethylene) or chronic overdosage of pyridoxine. 11 Malignancy, an uncommon cause of neuropathy, should be considered when the diagnosis is elusive. Tumor compression of peripheral nerves, nerve roots, spinal cord or the brain can cause paresthesias. Paraneoplastic syndromes from appalachian, cancers, particularly small cell carcinoma of the lung, can cause paresthesias. Visual Arts Essay Research Questions! 12 Lymphomas and tumors of the university, lung, stomach, breast and ovary have been associated with neuropathies. James! 13. FIGURE 1. Sensory dermatomes. FIGURE 2. Cutaneous nerve distribution of the appalachian state, upper limb. FIGURE 3. Cutaneous nerve distribution of the lower limb. Diabetic neuropathy generally has a graded, symmetric, distal glove and stocking type of distribution, usually with proximal progression from the websites, toes and feet, although other peripheral neuropathies may display this pattern. Appalachian State Application Essay! 14 A specific dermatomal pattern of paresthesias suggests a radiculopaty or herpetic neuralgia. Other notable patterns of paresthesias include areas of specific single nerves (mononeuropathy) or involvement of visual extended research questions, multiple nerves (mononeuritis multiplex). Appalachian State Application Essay! Paresthesias of multiple somatic locations should alert the physician to the possibility of multiple sclerosis. Worst Admission Essays! 15. is associate professor and state application essay, chair of the Department of Family Medicine at the University of Alabama School of Medicine, Tuscaloosa. Dr. McKnight graduated from the college admission essays, University of appalachian, Tennessee, Memphis, College of extended questions, Medicine and completed a residency at the Tuscaloosa Family Practice Residency Program. is an assistant professor and director of appalachian university essay, family medicine predoctoral education in visual essay, the Department of appalachian application, Family Medicine at the University of in india, Alabama School of Medicine, Tuscaloosa. Dr. State University Application Essay! Adcock graduated from the University of Mississippi School of Medicine in Jackson and completed a residency at the Tuscaloosa Family Practice Residency Program. Patients presenting with complaints of paresthesias should have a complete physical and neurologic examination. On Bpo Industry! The physical examination should be used to help rule out metabolic or systemic causes of appalachian state application, neuropathies. The neurologic examination should test for motor and sensory functions, the writer websites, latter being perhaps the most difficult part of the appalachian state university, examination. The primary sensory examination should focus on the patient's response to pain, touch, vibration, joint position and thermal sensation. 9(pp130-47) This examination will test major afferent pathways of henry james pupil, both primary sensation and cortical sensory function. It is quite possible to have symptoms of paresthesias with no measurable neurologic deficit. Complete blood cell count. Nerve conduction velocities. Magnetic resonance imaging. Computed tomographic scan. Purified protein derivative (PPD) Heavy metal analysis. The laboratory examination ( Table 5 ) is a vital aspect in the evaluation of paresthesias. Basic laboratory evaluation should begin with a complete blood cell count, a chemistry profile, a urinalysis and determination of thyrotropin-stimulating hormone and sedimentation rate. 19 Depending on the clinical situation, additional serologic tests, including measurement of folate an vitamin B 12 levels, VDRL, antinuclear antibodies and serum immunoelectrophoresis, should be considered. Appalachian State University Application Essay! 19 A purified protein derivative (PPD) tuberculin should be applied, if clinically indicated. Heavy metal analysis of serum for college admission essays, the presence of lead, mercury or arsenic may be necessary. Tests of nerve conduction velocity and electromyography should be ordered if the laboratory tests do not provide a diagnosis. 20,21 Radiologic studies should focus on a specific anatomic area, such as evaluation of a suspected lumbar radiculopathy. State Essay! Evaluation of on bpo industry, a suspected herniated disc should include magnetic resonance imaging (MRI), myelography or computed tomography of the affected area. Dorland's Illustrated medical dictionary. 28th ed. Philadelphia: Saunders, 1994. The exteroceptive sensations. In: Haerer AF, ed. DeJong's The neurologic examination. 5th ed. Philadelphia: Lippincott, 1992:47-66. Numbness, tingling, and sensory loss. In: Isselbacher KJ, Braunwald E, Wilson JD, et al., eds. Harrison's Principles of internal medicine. 13th ed. New York: McGraw-Hill, 1994:133-6. Thompson HG, Rowland LP. Pain and paresthesias. In: Rowland LP, ed. Merritt's Textbook of neurology. 8th ed. Philadelphia: Lea & Febiger, 1989:28-31. Diseases of the peripheral nervous system. In: Scientific American medicine. New York: Scientific American 1994;11:1-15. Entrapment neuropathies of the appalachian university application essay, upper extremities. N Engl J Med 1993;329:2013-8. Dawson DM, Hallett M, Millender LH, eds. Entrapment neuropathies. 2d ed. Boston: Little, Brown, 1990:93-124. Signs and symptoms in neurology. In: Disorders of sensation. Philadelphia: Lippincott, 1984:206-302. Adams RD, Victor M, eds. Principles of neurology. 5th ed. New York: McGraw-Hill, 1993. Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy. A review. Arch Neurol 1987;44:555-61. Toxic and environmental disorders of the nervous system. In: Walton J, ed. Brain's Diseases of the writer websites, nervous system. 10th ed. Oxford, England: Oxford University Press, 1993:513-29. Secondary neoplastic disease. In: Asbury AK, McKhann GM, McDonald WI, eds. Diseases of the nervous system: clinical neurobiology. Philadelphia: Saunders, 1992:1093-1104. In: Asbury AK, McKhann GM, McDonald WI, eds. Diseases of the nervous system: clinical neurobiology. Philadelphia: Saunders, 1992:1105-20. Brown MJ, Asbury AK. Ann Neurol 1984;15:2-12. Sibley WA, Poser CM, Alter M. Multiple sclerosis. In: Rowland LP, ed. University Essay! Merritt's Textbook of neurology. 8th ed. Philadelphia: Lea and Febiger, 1989: 741-60. The nervous system: Techniques of arts essay, examination. In: Bates B, Bickley LS, Hoekelman RA, eds. A guide to physical examination and state application essay, history taking. Essay Websites! 6th ed. Philadelphia: Lippincott, 1995:505-40. The neuropsychiatric examination. In: DeGowin RL, ed. University Application! DeGowin and DeGowin's bedside diagnostic examination. 5th ed. New York: Macmillan, 1987:780-852. Hereditary motor and sensory neuropathy. Extended Research! In: Brain's Diseases of the nervous system. 10th ed. Oxford, England: Oxford University Press, 1993:590-2. Illustrated manual of neurologic diagnosis. 2d ed. Philadelphia: Lippincott, 1982:200-1. Common focal mononeuropathies and their electrodiagnosis. J Clin Neurophysiol 1993; 10:181-9. Microneurography, impulse condition, and state university, paresthesias. Muscle Nerve 1993;16:1025-32. Copyright 1997 by the American Academy of Family Physicians. This content is owned by worst admission the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Appalachian State Application! This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in henry james pupil essay, writing by the AAFP.