GUESS THAT DIAGNOSIS: Numbness, Tingling, and Mild confusion


GUESS THAT DIAGNOSIS: Numbness, Tingling, and Mild Confusion


A 66 year old patient comes in with complaints of numbness and tingling in their fingers and toes. This patient also complains about some mild confusion. This has been ongoing for the last 11 months.

Review of systems: She complains of numbness and tingling in upper and lower extremities. She has had some mild confusion and forgetfulness that has been increasing over the last several months. She denies any unilateral weakness, facial droop, falls, dysphagia. She denies any fever, chills, chest pain, shortness of air, nausea, vomiting, abdomen pain.

Family history: Heart disease. Denies family hx of dementia, parkinsons, strokes

Surgical history: Includes gastric bypass, appendectomy, and tonsillectomy. Denies any back surgeries

Lifestyle: Former smoker (quit 3 yrs ago), recently went vegetarian 11 months ago, social ETOH use (1-2 times a month), good social support

Medications: Protonix, Claritin, Metformin, Spironolactone, Lisinopril

Medical history: Seasonal Allergies, GERD, PCOS, hypertension

Physical exam (just abnormal finds listed): Decreased sensation to vibration, generalized pale appearance, positive Romberg test, angular cheilitis, mild cognitive impairment-forgetful

Labs: CBC: elevated MCV, low hematocrit, Chemistry: normal, TSH normal, A1C normal, B12 low

Imaging: CT head normal, CXR normal, Carotid Doppler normal




RISK: Gastric bypass history, vegan or vegetarian diet, PPI and or Metformin use.

Complaints: Numbness & tingling in extremities, confusion

Physical Exam: Ataxia, angular cheilitis, glossitis (usually a late sign), dementia like symptoms (uncommon), positive Romberg test, pallor, petechiae, decreased sensation to vibration

Labs: B12 low, elevated mcv, low hematocrit, low reticulocyte count

Differential Dx: Diabetic Neuropathy, Stroke, Dementia, Hypothyroidism, Pernicious Anemia…. (these are just a few)

DISCLAIMER: The information posted is not intended to be medical advice. This is for educational purposes only. This information is intended for medical professionals & students. All patients should ALWAYS check with their primary care provider with any questions regarding their health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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