Differential Diagnosis for Bilateral Extremity Numbness
Single Most Likely Diagnosis
- Multiple Sclerosis (MS): A demyelinating disease that can present with numbness, tingling, or weakness in various parts of the body, including bilateral extremities. The fact that the numbness is worse on one side could indicate a plaque in the central nervous system affecting the sensory pathways.
Other Likely Diagnoses
- Peripheral Neuropathy: Conditions such as diabetic neuropathy, vitamin B12 deficiency, or alcohol-related neuropathy can cause bilateral extremity numbness. However, these typically present with symmetrical symptoms.
- Cervical Spondylosis or Disc Disease: Can cause numbness or tingling in the arms due to compression of the spinal cord or nerve roots. The asymmetry could be due to uneven compression.
- Fibromyalgia: A chronic condition characterized by widespread musculoskeletal pain, fatigue, and tender points. While not typically causing numbness, it can cause paresthesias and is more common in women.
Do Not Miss Diagnoses
- Spinal Cord Compression: Conditions like spinal stenosis, tumors, or abscesses can compress the spinal cord, leading to numbness, weakness, and potentially severe consequences if not promptly addressed.
- Guillain-Barré Syndrome: An autoimmune disorder that can cause rapid-onset muscle weakness and numbness, often following an infection. It's crucial to identify early due to the potential for respiratory failure.
- Vitamin B12 Deficiency: While more commonly associated with symmetrical symptoms, a severe deficiency can lead to subacute combined degeneration of the spinal cord, causing numbness, weakness, and gait difficulties.
Rare Diagnoses
- Neurosyphilis: A condition caused by the spread of syphilis to the nervous system, which can present with a wide range of neurological symptoms, including numbness.
- Sjögren's Syndrome: An autoimmune disorder that can cause peripheral neuropathy among other symptoms, leading to numbness or tingling in the extremities.
- Vasculitis (e.g., Polyarteritis Nodosa): Inflammation of the blood vessels can lead to nerve damage and numbness, though this would be an uncommon presentation.
- Tumors (e.g., Neurofibromas, Meningiomas): Rarely, tumors along the spinal cord or nerve roots can cause localized or widespread numbness, depending on their location and size.