n.

錯感覚、知覚異常、感覚異常、異常知覚

定義

Mainly spontaneous abnormal sensation that is not unpleasant; usually described as "pins and needles".(疼痛#痛みと異常知覚の命名法)
There may be peculiar sensations without an obvious stimulus, called paresthesias. These occur commonly when an arm or leg “goes to sleep” following compression of a nerve, and may be described as tingling, prickling, or feelings of warmth, coldness, or pressure. ( Bates Guide to Physical Examination p.550より抜粋)

WordNet

abnormal skin sensations (as tingling or tickling or itching or burning) usually associated with peripheral nerve damage (同)paraesthesia
hallucinated sensation that insects or snakes are crawling over the skin; a common side-effect of extensive use of cocaine or amphetamines

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/03/11 16:08:38」(JST)

wiki en

[Wiki en表示]

This article is about the physical condition. For other uses, see Pins and Needles (disambiguation).

Paresthesia (/ˌpærɨsˈθiːziə/ or /ˌpærɨsˈθiːʒə/), spelled paraesthesia in British English, is a sensation of tickling, tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep". The manifestation of paresthesia may be transient or chronic.

Etymology

Look up paresthesia in Wiktionary, the free dictionary.

Greek para ("beside", i.e., abnormal) and aisthesia ("sensation").

Cause

Transient

Paresthesias of the hands and feet are common, transient symptoms of the related conditions of hyperventilation syndrome, often open mouth, and panic attacks.

Other common examples occur when sustained pressure has been applied over a nerve, inhibiting/stimulating its function. Removing the pressure will typically result in gradual relief of these paresthesias.^[1]

Chronic

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. It can also be a symptom of mercury poisoning.

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. Neuropathy is also a side effect of some chemotherapies.^[2] Benzodiazepine withdrawal may also cause paresthesia 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 disease (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 paresthesia. 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.

Acroparesthesia

Acroparesthesia is severe pain in the extremities, and may be caused by Fabry disease, a type of sphingolipidosis.^[3]

Other

Other causes may include:

anticonvulsant pharmaceutical drugs, such as topiramate, sultiame, and acetazolamide
anxiety and/or panic disorder^[4]
benzodiazepine withdrawal syndrome
carpal tunnel syndrome
chiari malformation
complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD)
beta-alanine
beta blocker
celiac disease
decompression sickness
dehydration
dextromethorphan (recreational use)
Fabry disease
fibromyalgia
Fluoroquinolone Toxicity
Guillain–Barré syndrome (GBS)
heavy metals
hydroxy alpha sanshool, a component of Sichuan peppers
hyperglycemia (high blood sugar)
hyperkalemia
hyperventilation
hypoglycemia (low blood sugar)
Hypomagnesemia, often as a result of long term Proton-pump inhibitor use
hypothyroidism
immunodeficiency, such as chronic inflammatory demyelinating polyneuropathy (CIDP)

intravenous administrating of strong pharmaceutical drugs acting on the central nervous system (CNS), mainly opioids, opiates, narcotics; especially in non-medical use (drug abuse)
lidocaine poisoning
Lomotil
menopause
mercury poisoning
migraines
multiple sclerosis
nitrous oxide, long-term exposure ^[5]
obdormition
pyrethrum and pyrethroid (pesticide)^[6]
rabies
radiation poisoning
sarcoidosis
spinal disc herniation or injury
stinging nettles
syringomyelia
transverse myelitis
vitamin B₅ deficiency
vitamin B₁₂ deficiency
withdrawal from certain selective serotonin reuptake inhibitors (or serotonin-specific reuptake inhibitors) (SSRIs), such as paroxetine and venlafaxine

Diagnostic approach

The nerve conduction study usually provides useful information for making diagnosis. A CT scan is sometimes used to rule out some causes from the central nervous system.

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.

Paresthesia caused by shingles is treated with appropriate antiviral medication.

References

^ Paresthesia Information Page: National Institute of Neurological Disorders and Stroke. (NINDS)
^ "Chemotherapy-induced Peripheral Neuropathy". National Cancer Institute. http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2010/022310/page6. Retrieved 1 December 2011.
^ Marks, Dawn B.;Swanson, Todd; Kim, Sandra I.;Glucksman, Marc (2007). Biochemistry and Molecular biology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-8624-X.
^ Ietsugu, T; Sukigara, M, Furukawa, TA (Dec 2007). "Evaluation of diagnostic criteria for panic attack using item response theory: findings from the National Comorbidity Survey in USA.". Journal of Affective Disorders 104 (1-3): 197–201. doi:10.1016/j.jad.2007.03.005. PMID 17434598. http://www.ncbi.nlm.nih.gov/pubmed/17434598.
^ Nitrous Oxide
^ Vijverberg, H.P., van den Bercken, J. Crit. Rev. Toxicol. (1990) Neurotoxicological effects and the mode of action of pyrethroid insecticides.

[Clinical and neurological abnormalities in adult celiac disease, G. Cicarelli • G. Della Rocca • M. Amboni • C. Ciacci • G. Mazzacca • A. Filla • P. Barone,

Neurol Sci (2003) 24:311–317 DOI 10.1007/s10072-003-0181-4]

External links

paresthesia at NINDS
What makes your arms, legs and feet fall asleep?

UpToDate Contents

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1. 末梢神経疾患および筋疾患の鑑別診断 differential diagnosis of peripheral nerve and muscle disease
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English Journal

The dependence of age on ulnar nerve conductive study parameter adaptation after compressive ulnar neuropathy operations in the elbow.

Radka N1, Oldřich V, Edvard E, Martin K, Martin S, Aleš P, Kunc P, Martin V.
Acta neurochirurgica.Acta Neurochir (Wien).2015 Sep;157(8):1405-9. doi: 10.1007/s00701-015-2489-2. Epub 2015 Jul 2.
BACKGROUND: According to some studies, peripheral nerve injury healing is prolonged in elderly patients. Compressive ulnar neuropathy in the elbow (UNE) is the second most common compressive mononeuropathy. To our knowledge, no study has investigated the effect of age on the postoperative ulnar nerv
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Rauso R1, Salti G1.
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A Prospective 1-Year Comparative Study of Endoscopic Thyroidectomy Via a Retroauricular Approach Versus Conventional Open Thyroidectomy at a Single Institution.

Chung EJ1, Park MW, Cho JG, Baek SK, Kwon SY, Woo JS, Jung KY.
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PMID 25605517

Japanese Journal

Syringomyelia and Arachnoid Cysts Associated With Spinal Arachnoiditis Following Subarachnoid Hemorrhage —Case Report—

Ishizaka Shunsuke,Hayashi Kentaro,Otsuka Munehiro,Fukuda Shuji,Tsunoda Keishi,Ushijima Ryujiro,Kitagawa Naoki,Suyama Kazuhiko,Nagata Izumi
Neurologia medico-chirurgica 52(9), 686-690, 2012-09-25
… However, abdominal paresthesia was persisted. …
NAID 120005230501

Syringomyelia and Arachnoid Cysts Associated With Spinal Arachnoiditis Following Subarachnoid Hemorrhage

ISHIZAKA Shunsuke,HAYASHI Kentaro,OTSUKA Munehiro,FUKUDA Shuji,TSUNODA Keishi,USHIJIMA Ryujiro,KITAGAWA Naoki,SUYAMA Kazuhiko,NAGATA Izumi
Neurologia medico-chirurgica = 神経外科 52(9), 686-690, 2012-09-15
… However, abdominal paresthesia was persisted. …
NAID 10030873259

視神経脊髄炎(NMO)の治療をめぐって

藤原一男
日本臨床免疫学会会誌 = Japanese journal of clinical immunology 35(2), 129-135, 2012-04-28
視神経脊髄炎（Neuromyelitis Optica, NMO）は重度の視神経炎と横断性脊髄炎を特徴とする免疫性中枢神経疾患でありDevic病とも呼ばれてきた．NMOは女性に多く，重度の機能障害を遺し，脊髄病変は3椎体以上の長い病変を呈する．脳病変もまれではない．NMOと多発性硬化症（MS）の関係は長い間議論されてきたが，NMO患者の血中には疾患特異的な自己抗体（抗aqu …
NAID 10030573799

Related Pictures

★リンクテーブル★

リンク元	「低カルシウム血症」「疼痛」「区画症候群」「しびれ」「動脈損傷」
拡張検索	「distal paresthesia」「painful paresthesia」

「低カルシウム血症」

Paresthesia
ICD-10	R20.2
ICD-9	782.0, 355.1
MeSH	D010292

　　[★]

英: hypocalcemia
同: 低Ca血症
関: カルシウム

血清カルシウム：8.0 mg/dl以下

病態生理

低カルシウム血症　→　2価陽イオンによる膜安定効果が消失(遮蔽効果↓、結合効果↓)　→　細胞膜の脱分極傾向 (SP.99)

病因

原発性副甲状腺機能低下症（PTHの分泌低下）DiGeorge症候群、自己免疫性
副甲状腺ホルモン受容体異常
高リン血症

腎不全→高リン血症→相対的低Ca血症

ビタミンDの欠乏：腎不全→活性型にする酵素は腎臓にあるので活性化されない。

ネフローゼ症候群、Fanconi症候群

過換気症候群：呼吸性アルカローシスにより一過性に低カルシウム血症をきたしうる。

新生児

QB.O-84

未熟児、母体糖尿病児、帝王切開児に多い

心電図パーフェクトマニュアル.221

低カリウム血症

症候

精神・神経：
筋と神経の被刺激性の亢進：筋緊張の亢進(テタニー)、腱反射亢進、クヴォステク徴候、トルソー徴候、異常感覚、情緒不安定
消化器：(時に)嘔吐、下痢。

急性症状

参考1

眼：乳頭浮腫

神経・筋の易刺激性(テタニー)

感覚異常(口・四肢)、筋痙攣、手・足の攣縮(carpopedal spasm)、トルソー徴候(手の症状)、クヴォステク徴候(顔面神経の)、てんかん発作、喉頭痙攣、気管支痙攣

心臓：QT延長、低血圧、心不全、不整脈　　←　心収縮力低下

慢性症状

参考1

異所性石灰化(大脳基底核)　　←　　P優位なCa・P積の上昇

錐体外路症状
パーキンソン症候群
認知症

嚢下白内障(subcapsular cataract)
歯牙異常
皮膚乾燥

テタニー

参考1

低カルシウム血症により末梢神経・筋肉の易刺激性亢進。EMG上、1つの刺激で高頻度の放電が見られる。テタニーはイオン化Ca 4.3mg/dL、カルシウム7.0-7.5 mg/dL未満で起こるのが一般的。テタニーは慢性腎不全(低カルシウム血症＋代謝性アシドーシス)では稀
最初は口の周りあるいは末梢の錯感覚(paresthesia)ではじまる。ぎこちなさとこわばり、筋痛、および筋攣縮・筋痙攣を呈する。呼吸筋と舌の攣縮はチアノーゼを起こしうる。自律神経の症状は発汗、期間攣縮、胆道疝痛 biliary colicを含む。　←　オッディ括約筋が収縮して腹痛を生じるらしい(080A040)

検査

Chvostek徴候；耳介の前方、顎関節の上の部分をハンマーで軽くたたくと顔面筋と眼輪筋の痙攣が起こる。
Trousseau徴候；上肢の血圧計マンシェットを巻き、収縮期と拡張期の中間血圧で１～２分圧迫すると上肢の筋の攣縮により、手首と親指が屈曲し他の手指は伸展して手掌が凹む。

心電図

QT延長　→　心室細動リスク

QTの延長はSTの延長による。T波の幅は変えないので、心房全体の再分極相の不均一化は起こりにくい。だからQT延長で多形性心室頻拍が起こることは少ないらしい(心電図の読み方 p.221-223)。

STの延長 = 2相(プラトー相)　絶対不応期と考えられる。

T波 = 3相　受攻期　相対不応期にあたる。ここが延長しなければ不整脈のリスクは高くないということか・・・ほんと？

QRS幅の拡大は伴わない

治療

グルコン酸カルシウム、活性型ビタミンD

腎臓内科レジデントマニュアル p.47

軽症：補正Ca＞8mg/dL

食事あるいはサプリメントでのカルシウム経口摂取 1日1000mg以上

無症候性で中等度(補正Ca濃度＜8mg/dL)の場合

炭酸カルシウム 3-6g
ビタミンD製剤：アルファカルシドール、ロカルトロール(アルファカルシドールの半量でよい)

アルファカルシドール 2-6μg/日特発性副甲状腺機能低下症
アルファカルシドール 1-3μg/日偽性副甲状腺機能低下症

→尿Ca/Cre比が0.3g/gCreを越えないように注意する

高度(補正Ca濃度＜7mg/dL)の場合

1. カルチコール 10-20mlを5分程度以上掛けて静注する
2. カルチコール 2-4ml/hrでCVからDIV
1. or 2.に加え)炭酸カルシウム9-12g/日、ビタミンD(アルファカルシドール 3μg/日)を開始して徐々にカルチコールを減少させる。また低マグネシウム血症があれば硫酸マグネシウムIV

参考

1. [charged]Clinical manifestations of hypocalcemia - uptodate [1]

「疼痛」

　　[★]

英: pain, dolor
同: 痛み
関: 痛覚 pain sensation

疼痛

疼痛の伝達

Aδ線維
C線維

疼痛の調節

ゲートコントロール：Aδ線維とC線維による痛みはAβ線維による入力で中枢伝達細胞のレベルで抑制される。
下行性疼痛抑制系神経系：下行性疼痛抑制系神経系による入力で中枢伝達細胞のレベルで抑制される。

下行性疼痛抑制系神経系は中脳水道周辺灰白質からの脊髄への入力からなる。具体的には大縫線核(セロトニン作動性)、巨大細胞網様核・傍巨大細胞網様核(ノルアドレナリン作動性)がの2系統が起点となる。抗うつ薬はこれらの神経伝達物質の再吸収を妨げ鎮痛作用を発揮する。

痛みと異常知覚の命名法

Adams and s Principles of Neurology, Ninth Edition Allan Ropper. table 8-2より抜粋

dysesthesia : Any abnormal sensation described as unpleasant by the patient.
hyperalgesia : Exaggerated pain response from a normally painful stimulus; usually includes aspects of summation with repeated stimulus of constant intensity and aftersensation.
hyperpathia : Abnormally painful and exaggerated reaction to a painful stimulus; related to hyperalgesia.
hyperesthesia (hypesthesia) : Exaggerated perception of touch stimulus.
allodynia : Abnormal perception of pain from a normally nonpainful mechanical or thermal stimulus; usually has elements of delay in perception and of aftersensation.
hypoalgesia (hypalgesia) : Decreased sensitivity and raised threshoid to painful stimuli.
anesthesia : Reduced perception of all sensation, mainly touch.
pallanesthesia : Loss of perception of vibration.
analgesia : Reduced perception of pain stimulus.
paresthesia : Mainly spontaneous abnormal sensation that is not unpleasant; usually described as "pins and needles".
causalgia : Buming pain in the distribution of one or more peripheral nerves.