Paraesthesia
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7352.1501 (Published 22 June 2002) Cite this as: BMJ 2002;324:1501All rapid responses
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The article by Pal B fails to mention two important aspects that
should be reviewed in patients who present with paraesthesia. The first is
that tingling and numbness are the commonest symptoms of hyperventialtion
associated with panic attacks and anxiety states. This can be excluded
eary in most conculations. Secondly, praestesia is the commonest
manifestation of hypocalcaemia, although this is not mentioned at all in
the article. Hypoparathyroidism is an important cause of hypocalcaemia.
With increasing numbers of operations being performed for primary and
tertiary hyperparathyroidism there will be a commensurate increase in the
number of patients who will develop post-operative hypocalcaemia. This is
often a short lived and reversible problem caused by the "hungry bone
syndrome". Hypocalcaemia and hypomagnesaemia are found on biochemical
testing. Long term supplementation with oral vitamin D analogues and
calcium is required when all parathyroid glands have been removed
deliberately (in tertiary hyperparathyroidism) or inadvertently (during
total thyroidectomy). Avoiding symptomatic hypocalcaemia often requires
dose titration and it is important that this is recognised. With the
increasing trend towards day case surgery this problem may be encountered
with greater frequency in primary care. To the list of issues that should
be covered in a consultation, I would add: Are there any symptoms to
suggest panic attacks. Ask about previous thyroid/parathyroid surgery.
Examine neck for evidence of a scar from previous endocrine surgery. Check
serum calcium and magnesium levels on a serum sample.
EPL Turton specialist registrar surgery
Dept of breast and endocrine surgery
St James's Teaching Hospital, Leeds LS97TF.
Tel: 07973 836466
Competing interests: No competing interests
Other causes of paraesthesias
There are other very interesting causes of paraesthesia in the hands
and fingers, that are linked to pathologies of the rachis. Excluded
serious clinical pathologies like bone cancer, osteoporosis,scoliosis,
trauma and others; there are patients suffering of paraesthesias ,often
with pain in the hands and forearm that are due to the inflammation and
ischemia of the nervous fibers belonging to the lower cervical and upper
thoracic rachis. These patients, when there are no contraindications ,
after few manipulations of the vertebral column often report a complete
recovery . I think this type of benign ostheoarticular vertebral disease
should be considered in the differential diagnosis of paraesthesias of the
hand and forearm.
Thank you very much for your attention,
best wishes,
Luigi Gori, MD
Service of Chirotherapy,
Clinical Center of Natural Medicine,
S. Giuseppe Hospital,
Az USL 11 - via Paladini 12,
50053 Empoli (Florence)- I
http.medicinanaturale.usl11.toscana.it
Competing interests: No competing interests