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Neurology (Expert Forum)
tingling in fingers and toes
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Doctor's Answer
by Lama Chahine, MD, Oct 25, 2008 10:36AM
, Oct 25, 2008 10:36AM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the cause of your symptoms are. however, I will try to provide you with some possibilities regarding tingling in the fingers and toes.
If this occurs in the setting of anxiety or stress, when you are breathing fast and shallow (what is termed hyperventilation) this could just be due to the changes in the blood that occur with this type of breathing pattern, and the solution would be slower deeper breaths.
There are other non-neurologic causes of tingling that will not be discussed here.
One neurologic diagnosis that comes to mind with more chronic, daily tingling in the fingers and toes is neuropathy. This would be particularly likely if you suffer from diabetes and other conditions discussed below. Please understand that i am not implying I think you have a neuropathy.
There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, the EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. The causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles ) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required. A normal nerve biopsy does not exclude a neuropathy.
If tingling only occurs in one limb or one side of the body is a spinal cord or brain problem. This would usually be associated with other symptoms besides tingling such as sensory loss or weakness. Diagnosis after physical exam and history may include an MRI.
I suggest you let your primary doctor/family physician know about your symptoms. He/she may determine that you may benefit from evaluation by a neurologist. After he/she examines you, he/she may choose to order further testing. If neuropathy is due to diabetes, control of the diabetes helps prevent worsening of the neuropathy. Some types of neuropathy have treatments, in others, there are medications to help the symptoms.
Thank you for using the forum I hope you find this information useful good luck.
Without the ability to examine you and obtain a history, I can not tell you what the cause of your symptoms are. however, I will try to provide you with some possibilities regarding tingling in the fingers and toes.
If this occurs in the setting of anxiety or stress, when you are breathing fast and shallow (what is termed hyperventilation) this could just be due to the changes in the blood that occur with this type of breathing pattern, and the solution would be slower deeper breaths.
There are other non-neurologic causes of tingling that will not be discussed here.
One neurologic diagnosis that comes to mind with more chronic, daily tingling in the fingers and toes is neuropathy. This would be particularly likely if you suffer from diabetes and other conditions discussed below. Please understand that i am not implying I think you have a neuropathy.
There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, the EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. The causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles ) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required. A normal nerve biopsy does not exclude a neuropathy.
If tingling only occurs in one limb or one side of the body is a spinal cord or brain problem. This would usually be associated with other symptoms besides tingling such as sensory loss or weakness. Diagnosis after physical exam and history may include an MRI.
I suggest you let your primary doctor/family physician know about your symptoms. He/she may determine that you may benefit from evaluation by a neurologist. After he/she examines you, he/she may choose to order further testing. If neuropathy is due to diabetes, control of the diabetes helps prevent worsening of the neuropathy. Some types of neuropathy have treatments, in others, there are medications to help the symptoms.
Thank you for using the forum I hope you find this information useful good luck.
Member Comments (2)
by johnjer, Oct 26, 2008 06:24PM
To: Lama Chahine, MD
I take immune suppression drugs. I have had high dosage of predinzone. I also have a conary diease and take beta blocker plavix, comduim. I have had numbness and coldness in my toes and a slight tingling in fingers. The doctors believe it is neuropathy. What kind do you think it is Steriod Diabetes? or something else?
by nida090909, Sep 16, 2009 05:26AM
A related discussion, Small fiber neuropathy was started.
