EpistemisPerioral dysesthesia
Specialty: Neurology.
Why it occurs
- Psychogenic hyperventilation (respiratory alkalosis due to anxiety or panic attack that decreases free ionized calcium in the blood)
- Acute hypocalcemia (consequent to hypoparathyroidism, surgical thyroid resection or severe vitamin D deficiency)
- Intoxication by marine toxins (ciguatera, saxitoxin due to ingestion of contaminated shellfish)
- Migraine with sensory aura of cheilo-oral distribution
- Multiple sclerosis with involvement of the trigeminal nuclei in the brain stem
Initial workup
Arterial or venous blood gases if respiratory alkalosis is suspected; measurement of total and ionized serum calcium, phosphorus, magnesium, and parathyroid hormone (PTH); electroencephalogram to rule out focal seizures of the parietal lobe; Brain MRI if there is suspicion of active multiple sclerosis plaque or stroke.
red flags
Sudden onset unilateral perioral dysesthesia associated with paresthesias in the ipsilateral hand (cheilororal syndrome) that progresses to facial or ipsilateral motor weakness, suggestive of transient cerebral ischemia or thalamo-capsular lacunar infarction.
Standard management
- 10% calcium gluconate — 1-2 slow intravenous ampoules diluted in glucose serum if severe symptomatic hypocalcemia is confirmed
- Benzodiazepines (e.g., Diazepam or Lorazepam) if the cause is a panic attack with hyperventilation
- Oral calcium carbonate and calcitriol for maintenance.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3