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A 73-year old man presents with pins and needles in his hand and simultaneously has a sensation of having a ‘curtain being pulled down’ over his right eye. Why?

NursingSKL clinical tip

By NursingSKL
September 11, 2023
iStock/ajr_images; NursingSKL

As a nurse, you will hear patients presenting with the sensation of “pins and needles.” There are two critical things to consider when assessing a patient with altered sensation:

  1. What is the location? The exact location can help differentiate if the cause is from pathology in the brain, spinal cord or peripheral nerve. For instance, in a stroke the paresthesias will be unilateral in nature. In a patient with bilateral pins and needles, it may be related to diabetic neuropathy, vitamin deficiency or another cause.
  2. Are there any associated symptoms? For instance, if a patient has paresthesias on one side of the body, which is associated with weakness, consider stroke. If the paresthesias are associated with blurred vision, and pain with ocular motility, consider multiple sclerosis. If associated with long-standing diabetes, retinopathy and neuropathy, consider peripheral diabetic neuropathy.

This patient presented with transient pins and needles from one hand (that did not map to either the ulnar or radial nerve distribution). The patient’s dilated retinal examination showed the presence of cloudy swelling intra-arterial refractive plaques (also called Hollenhorst plaques). Carotid doppler ultrasonography showed 60% carotid artery stenosis. The patient was diagnosed with a stroke and placed on antiplatelet agents.

Clinical tip: In a patient with paresthesias, the location and extent is critical in defining if the lesion is located in the brain, spinal cord or peripheral nerve.


In this video you will learn three critical questions that you need to ask any patient presenting with pins and needles.

This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
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