THEMEDPRACTICALEXAM.COM
History Taking Format for Paresthesia
1. Patient Details
Name, Age, Sex, Occupation, Address
2. Presenting Complaint
Description of abnormal sensation (e.g., tingling, numbness, burning, “pins and needles”)
Duration and progression
3. History of Presenting Illness
A. Onset and Course
Sudden or gradual onset?
Exact time and circumstances of onset
Course: Continuous, intermittent, or progressive?
Duration and frequency of symptoms
B. Distribution
Exact location (one limb, both limbs, specific fingers, face, trunk, etc.)
Unilateral or bilateral?
Proximal or distal?
Dermatomal, glove-and-stocking, or patchy distribution?
C. Character and Quality
Nature of sensation: Tingling, numbness, burning, crawling, electric shock, etc.
Severity (mild, moderate, severe)
Any associated pain (neuropathic pain)
D. Aggravating and Relieving Factors
Triggered or worsened by activity, rest, position, temperature, pressure, or time of day?
Relieved by movement, rest, or medications?
E. Associated Symptoms
Weakness, muscle wasting, twitching, or cramps
Loss of sensation (touch, pain, temperature, vibration)
Autonomic symptoms (sweating, color changes, swelling)
Gait disturbance, imbalance, or falls
Bladder or bowel dysfunction
Visual, speech, or swallowing difficulties
F. Previous Episodes
Any similar symptoms in the past?
Pattern and duration of recovery
4. Past Medical History
Diabetes mellitus, hypertension, thyroid disease, vitamin deficiencies
Previous neurological disorders (stroke, multiple sclerosis, epilepsy)
History of trauma, surgery, or radiation
Chronic kidney or liver disease, malignancy, autoimmune disorders, infections (e.g., HIV, Lyme disease)
5. Drug History
Current and recent medications (especially chemotherapeutic agents, antiretrovirals, isoniazid, metronidazole, phenytoin, etc.)
Recent changes in medication or missed doses
Alcohol, tobacco, or recreational drug use
6. Family History
Family history of neuropathy, neurological, or hereditary diseases
7. Personal and Social History
Occupation (exposure to toxins, repetitive movements, vibration tools)
Diet and nutritional status
Alcohol, tobacco, or illicit drug use
8. Systemic Enquiry
Fever, weight loss, night sweats (infection, malignancy)
Skin changes, rashes, joint pain (autoimmune, connective tissue disease)
Any other neurological or systemic symptoms
9. Special Notes
Source and reliability of history (especially if cognitive impairment is present)
Baseline functional status and impact on daily life
Key Points:
Precisely localize and characterize the paresthesia.
Identify associated neurological or systemic features.
Consider common etiologies: metabolic, compressive, inflammatory, infectious, toxic, hereditary, and idiopathic causes.
Case History
Personal Details:
Ms. Priya Sharma, 31-year-old female, office administrator
Presenting Complaint:
Tingling and numbness in both feet for 2 weeks
History of Presenting Illness:
Ms. Sharma reports that about two weeks ago, she began experiencing a tingling, “pins and needles” sensation in the soles of both feet. The sensation is present most of the day and is sometimes accompanied by mild numbness. She denies any weakness, pain, or gait disturbance. She has not noticed the symptoms spreading above her ankles or to her hands.
There is no history of recent trauma, back pain, or injury. She has not experienced similar symptoms in the past. She denies fever, weight loss, night sweats, or recent infections. She has not noticed any changes in urination or bowel habits.
She reports feeling more tired lately and has been under stress at work. She drinks alcohol socially (1-2 drinks per week) and does not smoke. Her diet is mostly vegetarian, and she admits to skipping meals due to her busy schedule.
Past Medical History:
Hypertension, diagnosed 2 years ago, on amlodipine
No diabetes, thyroid disease, or previous neurological illness
Drug History:
Amlodipine 5 mg daily
No recent medication changes or use of over-the-counter or herbal drugs
Family History:
No family history of neuropathy, neurological, or autoimmune diseases
Personal and Social History:
Office-based job, no exposure to toxins or heavy metals
No recent travel
Systemic Enquiry:
No visual changes, speech or swallowing difficulty, limb weakness, or imbalance
No skin rashes, joint pain, or swelling
Case Summary
A 31-year-old woman with hypertension presents with two weeks of persistent bilateral plantar tingling and numbness, without weakness, pain, or gait disturbance. No history of trauma, infection, diabetes, or toxin exposure. Diet is low in animal products.
Differential Diagnosis
Peripheral Neuropathy (Likely Nutritional/Vitamin Deficiency)
Early Diabetic Neuropathy
Less likely without a history of diabetes but should be considered if risk factors are present1.
Electrolyte Imbalance (e.g., Hypokalemia)
Possible, especially if dietary intake is poor or there is a history of vomiting/diarrhea1.
Alcohol-Related Neuropathy
Unlikely given low alcohol intake, but chronic use can contribute1.
Chronic Compressive Neuropathy (e.g., Tarsal Tunnel Syndrome)
Less likely due to bilateral, symmetrical symptoms and absence of localizing signs.
Early Demyelinating Disease (e.g., Multiple Sclerosis)
Possible but less likely without other neurological symptoms or relapsing-remitting course3.
Toxin Exposure or Medication-Induced Neuropathy
Unlikely with no history of relevant exposures or medication changes
Viva Questions and Answers on Paresthesia
1. What is paresthesia?
Paresthesia is an abnormal sensation, such as tingling, numbness, burning, or “pins and needles,” typically felt in the hands, feet, arms, or legs5.
2. What are the common causes of paresthesia?
Common causes include peripheral neuropathy (often due to diabetes), prolonged nerve compression, vitamin deficiencies (especially B12), multiple sclerosis, stroke, trauma, infections, and exposure to toxins or certain medications53.
3. How do you differentiate between peripheral and central causes of paresthesia?
Peripheral causes typically present with distal, symmetrical symptoms (e.g., glove-and-stocking distribution in neuropathy), while central causes may have associated motor deficits, sensory level, or other neurological signs (e.g., spinal cord or brain lesions)34.
4. What are the key points to ask in the history of a patient with paresthesia?
Onset (sudden or gradual)
Duration and progression
Exact location and distribution
Associated symptoms (weakness, pain, incoordination, bladder/bowel involvement)
Aggravating/relieving factors
Past medical history (diabetes, thyroid disease, trauma)
5. What are some important associated symptoms that may suggest a serious underlying cause?
Muscle weakness, bluish or cold skin, severe pain, sudden changes in vision, incoordination, urinary or fecal incontinence, and paralysis may indicate a more serious or emergent condition5.
6. What bedside tests can be used to assess paresthesia?
Bedside sensory tests include light touch, pinprick, vibration, and proprioception testing. The Semmes-Weinstein monofilament test is commonly used for peripheral neuropathy24.
7. What are the complications of untreated or severe paresthesia?
Potential complications include permanent nerve damage, disability, deformity, risk of ulceration or amputation (especially in diabetes), and impaired quality of life5.
8. What laboratory investigations are indicated in a patient with paresthesia?
Blood glucose, vitamin B12, folate, thyroid function, renal and liver function tests, and sometimes nerve conduction studies or imaging depending on clinical suspicion5.
9. How does vitamin B12 deficiency cause paresthesia?
Vitamin B12 deficiency leads to demyelination of peripheral nerves and the dorsal columns of the spinal cord, resulting in numbness, tingling, and sometimes ataxia.
10. What is the “glove-and-stocking” distribution, and what does it indicate?
It refers to paresthesia affecting the distal parts of the limbs (hands and feet) symmetrically, commonly seen in peripheral neuropathies, such as those caused by diabetes or nutritional deficiencies5.