Differential Diagnosis for 32 yo AA Female with Bilateral Leg Paresthesias

• Single Most Likely Diagnosis
  • Lumbar Radiculopathy: Given the patient's history of lower vertebral disc disease, the symptoms of worsening bilateral leg paresthesias, pain with prolonged standing and walking, and relief with sleeping are consistent with lumbar radiculopathy. The fact that her symptoms have been progressive over the course of 1 week and are not relieved by methocarbamol suggests a possible exacerbation of her underlying disc disease. Treatment with steroids is a reasonable approach, considering her NSAID allergy.
• Other Likely Diagnoses
  • Peripheral Neuropathy: The patient's symptoms of paresthesias and pain in her feet and legs could be indicative of peripheral neuropathy, which can be caused by various factors including diabetes, vitamin deficiencies, or autoimmune disorders.
  • Musculoskeletal Strain: Prolonged standing and walking could lead to musculoskeletal strain, causing pain and paresthesias in the legs and feet.
  • Vitamin Deficiency (e.g., Vitamin B12 deficiency): Deficiencies in certain vitamins, such as Vitamin B12, can cause paresthesias and neurological symptoms.
• Do Not Miss Diagnoses
  • Cauda Equina Syndrome: Although less likely, cauda equina syndrome is a serious condition that requires immediate attention. It is characterized by low back pain, bilateral leg weakness, and bowel or bladder dysfunction.
  • Spinal Cord Compression: Spinal cord compression can cause paresthesias, pain, and weakness in the legs, and can be a medical emergency if not promptly addressed.
  • Multiple Sclerosis: Although rare, multiple sclerosis can cause paresthesias, pain, and neurological symptoms, and should be considered in the differential diagnosis.
• Rare Diagnoses
  • Guillain-Barré Syndrome: An autoimmune disorder that can cause rapid onset of muscle weakness and paresthesias, which could be considered in the differential diagnosis, although it is relatively rare.
  • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): A rare autoimmune disorder that can cause paresthesias, pain, and neurological symptoms, which could be considered in the differential diagnosis.
  • Vasculitis (e.g., Giant Cell Arteritis): A rare condition that can cause paresthesias, pain, and neurological symptoms, which could be considered in the differential diagnosis, although it is relatively rare in this age group.