Differential Diagnosis for Nocturnal Vibration Sensation

The patient's symptoms of a vibration sensation in the body, occurring only at night, with normal blood pressure, normal glycemia, and no palpitations, can be approached by considering the following differential diagnoses:

• Single Most Likely Diagnosis

  • Restless Legs Syndrome (RLS): This condition is characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations such as vibration, usually worsening at night. The patient's age and the nocturnal nature of the symptoms align with RLS, making it a plausible diagnosis.

• Other Likely Diagnoses

  • Anxiety or Stress: Nocturnal exacerbation of anxiety or stress can manifest as internal vibrations or tremors, especially in the absence of other systemic symptoms.
  • Hypnic Jerks: These are sudden, brief contractions of the body that occur as one is falling asleep, which might be perceived as vibrations.
  • Nocturnal Leg Cramps: Though typically more painful, some patients might describe the sensation as a vibration before the cramp occurs.

• Do Not Miss Diagnoses

  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause a wide range of symptoms, including tremors or vibrations, though these are usually not limited to nighttime.
  • Vitamin Deficiencies (e.g., Vitamin B12): Deficiencies can lead to neurological symptoms, including abnormal sensations, though these are generally more widespread and not exclusively nocturnal.
  • Parkinson’s Disease: Early stages can present with subtle symptoms such as internal tremors or vibrations, especially at rest.

• Rare Diagnoses

  • Akathisia: A movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, which could be perceived as a vibration.
  • Friedreich’s Ataxia: A rare genetic disease causing progressive damage to the nervous system, which might include vibratory sensations among its myriad symptoms.
  • Wilson’s Disease: A genetic disorder leading to copper accumulation in the body, potentially causing neurological symptoms including tremors.

Each of these diagnoses should be considered in the context of a thorough medical history, physical examination, and appropriate diagnostic tests to determine the underlying cause of the patient's nocturnal vibration sensation.