What could be causing my symptoms of paresthesia (tingling) in the lower legs and feet, abnormal sensations in the arms, a heavy head, feeling disoriented, and difficulty recalling recent events, and how should they be managed?

Urgent Neurological Evaluation Required for Acute Multifocal Symptoms

Your symptom constellation—tingling in lower legs and feet, abnormal arm sensations, heavy head, disorientation, and recent memory difficulty—requires immediate emergency department evaluation to exclude acute stroke, spinal cord compression, or Guillain-Barré syndrome, all of which can cause permanent disability or death without urgent intervention. 1, 2, 3

Immediate Red Flags Present

Your symptoms meet multiple criteria for urgent neurological emergencies:

• Multifocal paresthesias (both legs, feet, and arms) with cognitive symptoms (memory difficulty, feeling "out of it") suggest either central nervous system pathology or acute peripheral nervous system disease 1
• Bilateral lower extremity numbness with cognitive impairment raises concern for cervical myelopathy (spinal cord compression) or posterior circulation stroke 4, 1
• Difficulty remembering yesterday combined with feeling disoriented and a "heavy head" are concerning for acute brain injury, including concussion, stroke, or metabolic encephalopathy 4, 2

Most Critical Diagnoses to Exclude First

Acute Stroke or TIA

You must be evaluated within hours, not days. The combination of bilateral sensory symptoms with cognitive changes (confusion, memory problems) can indicate posterior circulation stroke involving the brainstem or cerebellum 4, 2. Approximately 25% of patients presenting with acute neurological symptoms have cerebrovascular disease, and 75-80% may lack obvious focal deficits initially 4. The 10% risk of completed stroke occurs within the first week, with highest risk in the first 48 hours 3.

Cervical Myelopathy (Spinal Cord Compression)

Bilateral leg numbness/tingling with arm symptoms and cognitive changes ("heavy head," disorientation) are alarm symptoms for spinal cord compression 4, 1. This requires MRI within 12 hours if neurological symptoms are present 4. Causes include metastatic disease, epidural abscess, or acute disc herniation.

Guillain-Barré Syndrome

Acute onset, rapidly progressive, multifocal paresthesias require urgent evaluation to exclude Guillain-Barré syndrome, which can progress to respiratory failure within hours 1. The bilateral nature of your leg symptoms combined with arm involvement fits this pattern.

Required Emergency Evaluation

Imaging Studies

• Brain MRI with diffusion-weighted imaging is the preferred initial test to detect acute ischemic stroke, which CT may miss in the first 24 hours 4, 2, 3
• Full spinal column MRI if any concern for myelopathy exists, given bilateral leg symptoms 4, 1
• CT angiography from aortic arch to vertex to evaluate for carotid/vertebral artery disease or posterior circulation abnormalities 2, 3

Laboratory Evaluation

• Glucose/HbA1c, thyroid function, vitamin B12, renal function to exclude metabolic causes of peripheral neuropathy 1
• Serum ferritin if restless legs syndrome suspected (though your symptoms are more acute and severe) 4

Secondary Differential Considerations

Peripheral Neuropathy

While diabetes, hypothyroidism, B12 deficiency, and alcohol can cause peripheral neuropathy, these typically produce bilateral symmetric symptoms that develop gradually over months to years, not acutely 4, 1. Your acute presentation with cognitive symptoms makes this less likely as the primary diagnosis.

Medication-Induced Symptoms

Pregabalin and similar medications can cause dizziness, somnolence, ataxia, confusion, thinking abnormal, memory impairment, and paresthesias 5. However, these are side effects in patients already taking the medication, not spontaneous symptoms requiring treatment.

Concussion

Your "heavy head," disorientation, and memory difficulty match postconcussion symptoms including numbness/tingling, feeling "in a fog," and difficulty remembering 4. If you had any head trauma in the past 48-72 hours, even seemingly minor, this must be disclosed immediately to emergency providers.

What You Must Do Now

Call 911 or go immediately to the nearest emergency department. Do not drive yourself. Inform EMS or triage that you have:

• Bilateral leg and arm numbness/tingling
• Difficulty remembering recent events
• Feeling disoriented and "out of it"
• Heavy head sensation

Time-sensitive interventions exist for stroke (within 4.5 hours for thrombolytics, up to 24 hours for thrombectomy) and spinal cord compression (within 12-24 hours for decompression) 2, 3, 4. Delays beyond these windows result in permanent neurological disability.

Critical Pitfall to Avoid

Do not assume these symptoms will resolve on their own or wait to "see if they get better." The combination of multifocal sensory symptoms with cognitive changes represents a neurological emergency until proven otherwise 1, 2, 3. Even if symptoms seem to improve temporarily, you remain at extremely high risk for progression or recurrence within hours to days.