What is the cause of bilateral lower extremity numbness and tingling in a 56-year-old patient with a history of Transient Ischemic Attack (TIA) and Hypertension (HTN)?

Differential Diagnosis for Numbness and Tingling in Bilateral Legs and Feet

Single Most Likely Diagnosis

• Peripheral Neuropathy: Given the patient's age and history of hypertension, peripheral neuropathy is a common condition that can cause numbness and tingling in the legs and feet. The patient's history of TIA (Transient Ischemic Attack) also increases the risk of developing peripheral neuropathy.

Other Likely Diagnoses

• Vitamin B12 Deficiency: A common cause of numbness and tingling in the legs and feet, especially in older adults. Vitamin B12 deficiency can be due to poor dietary intake, malabsorption, or certain medications.
• Diabetic Neuropathy: Although not explicitly mentioned, the patient's history of hypertension increases the risk of developing diabetes. Diabetic neuropathy can cause numbness and tingling in the legs and feet.
• Spinal Stenosis: A condition that can cause numbness and tingling in the legs and feet, especially when walking or standing. The patient's age and history of TIA increase the risk of developing spinal stenosis.

Do Not Miss Diagnoses

• Cauda Equina Syndrome: A rare but potentially devastating condition that requires urgent medical attention. Cauda equina syndrome can cause numbness and tingling in the legs and feet, as well as bowel and urinary dysfunction.
• Multiple Sclerosis: An autoimmune disease that can cause numbness and tingling in the legs and feet, as well as other neurological symptoms. Although less likely, multiple sclerosis should be considered in the differential diagnosis.
• Vascular Occlusion: A blockage of blood flow to the legs and feet can cause numbness and tingling. Given the patient's history of TIA and hypertension, vascular occlusion is a potentially life-threatening condition that should not be missed.

Rare Diagnoses

• Guillain-Barré Syndrome: A rare autoimmune disorder that can cause numbness and tingling in the legs and feet, as well as muscle weakness.
• Amyloidosis: A rare condition that can cause numbness and tingling in the legs and feet, as well as other systemic symptoms.
• Heavy Metal Poisoning: Exposure to heavy metals such as lead or mercury can cause numbness and tingling in the legs and feet. Although rare, heavy metal poisoning should be considered in the differential diagnosis, especially if the patient has a history of exposure.