Differential Diagnosis for Stocking and Glove Tingling with Impaired Proprioception

The patient's symptoms of stocking and glove tingling, impaired proprioception of upper and lower extremities, and decreased sensation in the lower limbs suggest a systemic process affecting the microvasculature. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Diabetes Mellitus: This condition is the most common cause of systemic microvascular disease, leading to neuropathy characterized by stocking and glove distribution of sensory deficits, including impaired proprioception and decreased sensation.

• Other Likely Diagnoses

  • Vitamin B12 Deficiency: Can cause demyelinating neuropathy affecting both the central and peripheral nervous systems, leading to impaired proprioception and sensory deficits.
  • Hypothyroidism: Sometimes associated with neuropathic symptoms, including sensory deficits and impaired proprioception, though less common than other causes.
  • Chronic Kidney Disease: Uremic neuropathy can present with similar symptoms, including sensory deficits and impaired proprioception, especially in advanced stages.

• Do Not Miss Diagnoses

  • Vasculitis (e.g., Rheumatoid Arthritis, Lupus): Although less common, vasculitis can cause microvascular damage leading to neuropathy. Missing this diagnosis could lead to significant morbidity and mortality if not treated promptly.
  • Amyloidosis: A rare condition that can cause systemic microvascular damage and neuropathy. It's crucial not to miss this diagnosis due to its potential for severe outcomes.

• Rare Diagnoses

  • Fabry Disease: A genetic disorder leading to systemic microvascular disease and neuropathy. It's rare but should be considered in younger patients or those with a family history.
  • Tangier Disease: Another rare genetic disorder affecting lipid metabolism, which can lead to neuropathy among other systemic manifestations.
  • Sjögren's Syndrome: An autoimmune disorder that can cause neuropathy, including small fiber neuropathy, though it's less commonly associated with the specific pattern of impaired proprioception and microvascular stenosis.

Each of these diagnoses has a different approach to management and treatment, emphasizing the importance of a thorough diagnostic workup to determine the underlying cause of the patient's symptoms.