What could be causing my whole body numbness, tingling, blurry vision, and perception of a chemical smell?

Immediate Emergency Evaluation Required for Possible Stroke or Seizure

Your symptoms of whole body numbness/tingling, chemical smell perception, and blurry vision require immediate emergency department evaluation to rule out stroke, seizure, or vertebrobasilar insufficiency—all life-threatening conditions requiring urgent intervention.

Critical First Steps in the Emergency Department

Immediate stroke assessment must be performed because the combination of whole body numbness with blurry vision represents high-risk neurological symptoms that could indicate posterior circulation stroke or vertebrobasilar insufficiency 1. The perception of a chemical smell (olfactory hallucination) combined with these symptoms raises concern for seizure activity 1.

Time-Sensitive Evaluation Protocol

• Check bilateral radial pulses and blood pressure in both arms immediately to differentiate stroke from acute arterial occlusion 2, 3
• Perform Cincinnati Prehospital Stroke Scale assessment including facial droop, arm drift, and speech abnormalities 3
• Patients presenting within 48 hours with these symptoms are at HIGH RISK with a 10% risk of completed stroke within the first week 2, 3

Urgent Neuroimaging Required

Brain MRI with diffusion-weighted imaging must be performed immediately as the preferred imaging modality to detect acute ischemic changes and differentiate ischemic from hemorrhagic stroke 2, 3. If MRI is unavailable, CT head without contrast should be performed to rule out hemorrhage 2, 3.

CT angiography or MR angiography from aortic arch to vertex is necessary to evaluate vertebrobasilar arterial disease, as your symptoms are classic for posterior circulation insufficiency 1, 2.

Differential Diagnosis Considerations

Vertebrobasilar Insufficiency (Most Likely Given Symptom Pattern)

Your symptom constellation is highly characteristic of vertebrobasilar arterial disease, which causes dizziness, vertigo, diplopia, perioral numbness, blurred vision, bilateral sensory deficits, and syncope 1. Vertebral artery atherosclerosis accounts for approximately 20% of posterior circulation strokes 1.

• Compromised vertebrobasilar perfusion can cause bilateral sensory symptoms affecting the whole body 1
• Blurred vision is a specific symptom of posterior circulation ischemia 1
• Visual disturbances in vertebrobasilar disease include blurring, enhanced brightness, loss of color, tunnel vision, and loss of vision 1

Seizure Activity (Second Most Likely)

The perception of a chemical smell (olfactory hallucination) is a classic seizure aura, particularly from temporal lobe dysfunction 1. An olfactory aura typically consists of an unusual unpleasant smell and may be accompanied by a rising sensation in the abdomen 1.

• Olfactory hallucinations strongly suggest temporal lobe seizure activity and require EEG evaluation 1
• Whole body tingling ("pins and needles") can occur before seizure events 1
• Blurred vision and visual disturbances can accompany seizure activity 1

Syncope/Pre-Syncope (Third Consideration)

Blurring of vision, constriction of visual field, and tingling sensations can occur during pre-syncopal states 1. However, the chemical smell perception makes this less likely as the primary diagnosis 1.

• Visual disturbances including blurred vision occur in all causes of syncope 1
• Tingling sensations may occur in hyperventilation-related syncope 1
• Sweating and pallor are common in neurally-mediated syncope 1

Diagnostic Testing Algorithm

Immediate Testing (Within Hours)

1. Brain MRI with diffusion-weighted imaging or CT head without contrast 2, 3
2. CT angiography or MR angiography from aortic arch to vertex to evaluate vertebrobasilar circulation 1, 2
3. Electroencephalography (EEG) if seizure suspected based on olfactory hallucination 1
4. Cardiac monitoring to exclude arrhythmias causing syncope 1

Secondary Evaluation (Within 24-48 Hours)

• Carotid and vertebral artery ultrasound if initial imaging suggests vascular disease 1
• Contrast-enhanced MRA has 94% sensitivity and 95% specificity for vertebral artery stenosis 1
• Catheter-based angiography may be required before revascularization if symptomatic posterior cerebral ischemia is confirmed 1

Treatment Based on Diagnosis

If Vertebrobasilar Insufficiency Confirmed

Dual antiplatelet therapy (aspirin + clopidogrel 75 mg) should be initiated for the first 21 days, followed by long-term single antiplatelet therapy 2, 3. This applies to patients with symptomatic vertebral artery stenosis not undergoing revascularization 2, 3.

• Medical management with antiplatelet therapy is the primary treatment 1
• Endovascular intervention carries 5.5% risk of periprocedural neurological complications 1
• Annual stroke risk after vertebrobasilar disease diagnosis is approximately 3% 1

If Seizure Confirmed

Antiepileptic therapy should be initiated based on EEG findings and neurological consultation 1. The specific agent depends on seizure type and patient factors 1.

If Syncope/Pre-Syncope Confirmed

Treatment depends on the underlying mechanism (cardiac arrhythmia, orthostatic hypotension, or neurally-mediated syncope) 1.

Critical Pitfalls to Avoid

Do not attribute these symptoms to Multiple Chemical Sensitivity (MCS) without excluding life-threatening neurological causes first. While MCS can cause symptoms during chemical exposure including perceived odor intensities and multisystemic symptoms 4, 5, the acute onset of whole body numbness with blurry vision and olfactory hallucination requires urgent stroke and seizure evaluation 1, 3.

Do not delay imaging for extensive laboratory testing—brain imaging must be performed immediately as outcome depends entirely on time to diagnosis and intervention 2, 3.

Do not assume symptoms are psychogenic or anxiety-related until objective neurological disease has been excluded with appropriate imaging and EEG 1.