Differential Diagnosis for Numbness that Comes and Goes

• Single Most Likely Diagnosis
  • Migraine: Numbness can be a symptom of migraine aura, which can come and go. Migraines are relatively common and can cause a variety of neurological symptoms, including numbness.
• Other Likely Diagnoses
  • Multiple Sclerosis (MS): MS is a condition that affects the brain and spinal cord, leading to symptoms like numbness, which can be intermittent. While not as common as migraines, MS is a well-known cause of numbness.
  • Peripheral Neuropathy: This condition results from damage to the peripheral nerves and can cause numbness that may come and go, depending on the underlying cause and the nerves affected.
  • Hyperventilation Syndrome: Hyperventilation can lead to symptoms of numbness and tingling, especially in the hands and feet, due to respiratory alkalosis.
• Do Not Miss Diagnoses
  • Transient Ischemic Attack (TIA) or Stroke: Although less common, TIAs or strokes can present with sudden numbness that may seem to come and go, especially if the patient is experiencing intermittent episodes of cerebral ischemia.
  • Vitamin B12 Deficiency: A deficiency in vitamin B12 can cause neurological symptoms, including numbness in the hands and feet. This condition is important not to miss because it is treatable with supplementation.
• Rare Diagnoses
  • Neuropathy due to Rare Causes: Such as amyloidosis, certain infections (e.g., Lyme disease), or autoimmune disorders (e.g., Guillain-Barré syndrome).
  • Complex Regional Pain Syndrome (CRPS): A condition characterized by intense burning or aching pain, typically in an arm or leg, which can also include symptoms of numbness.
  • Sjögren's Syndrome: An autoimmune disorder that can cause numbness among other symptoms, due to its effects on the nervous system.

Each of these diagnoses has a different set of implications for treatment and management, highlighting the importance of a thorough diagnostic workup for intermittent numbness.