What could be causing burning sensations in both arms, tingling in both lower legs, memory fog, short-term memory issues, and a feeling of being in a cloud?

Evaluation for Peripheral Neuropathy with Cognitive Symptoms

Your symptom constellation of burning arms, tingling legs, memory fog, short-term memory problems, and feeling "in a cloud" most strongly suggests peripheral neuropathy with concurrent cognitive dysfunction, requiring immediate evaluation for underlying systemic causes—particularly diabetes, vitamin B12 deficiency, thyroid disease, and autoimmune conditions. 1, 2

Primary Diagnostic Considerations

Peripheral Neuropathy Assessment

Your burning sensations in both arms and tingling in both lower legs represent classic neuropathic symptoms that warrant systematic evaluation 2:

• Burning pain and uncomfortable tingling (paresthesia) are hallmark features of peripheral neuropathy, affecting up to 50% of patients with this condition 2
• The bilateral distribution in both upper and lower extremities suggests a systemic rather than focal nerve compression etiology 2
• Critical distinction: Your symptoms affect both arms AND legs, which differs from the typical "stocking-glove" distribution of diabetic neuropathy that starts distally in feet first 1, 3

Cognitive Symptoms ("Brain Fog")

Your memory fog, short-term memory issues, and feeling "in a cloud" align with documented descriptions of brain fog 1:

• "Feeling like 'in a fog'" is a recognized symptom in multiple conditions including concussion, hypersomnia, and inflammatory states 1
• Difficulty remembering and concentrating are core features of cognitive dysfunction associated with various neurological conditions 1
• Brain fog commonly includes forgetfulness, difficulty concentrating, cognitive "slowness," and excessive mental effort 4, 5

Essential Diagnostic Workup

Immediate Laboratory Testing Required

You need comprehensive metabolic screening to identify treatable causes 1:

• Hemoglobin A1c and fasting glucose - diabetic neuropathy is a leading cause of peripheral neuropathy 1
• Vitamin B12 level - deficiency causes both neuropathy and cognitive impairment 1
• Thyroid function (TSH, free T4) - hypothyroidism causes both neuropathy and brain fog 1
• Complete blood count - to assess for anemia and other hematologic causes 1
• Comprehensive metabolic panel - to evaluate renal and hepatic function 1
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) - to screen for inflammatory/autoimmune conditions 1

Neurological Examination Components

Your clinical examination should specifically document 1:

• Temperature or pinprick sensation (small fiber function) 1
• Vibration sensation using 128-Hz tuning fork (large fiber function) 1
• 10-g monofilament testing on feet 1
• Ankle reflexes 1
• Exact distribution of sensory symptoms - distinguishing symmetric versus asymmetric patterns 2

Critical Differential Diagnoses to Exclude

Conditions Causing Both Neuropathy and Cognitive Symptoms

Several systemic conditions can produce your combined symptom pattern 1:

• Hypothyroidism - causes peripheral neuropathy and cognitive slowing 1
• Vitamin B12 deficiency - produces both peripheral neuropathy and memory impairment 1
• Autoimmune disorders (multiple sclerosis, lupus, vasculitis) - can affect both peripheral nerves and central cognition 1
• Chronic inflammatory states - neuroinflammation can cause both neuropathic pain and brain fog 6

Medication-Induced Causes

If you take any medications, review for neurotoxic effects 1:

• Chemotherapy agents - cause both peripheral neuropathy and "chemobrain" 1
• Certain psychiatric medications - can produce cognitive dulling 1
• Substances or drugs - hypersomnia and cognitive impairment can result from various substances 1

Sleep Disorders

Hypersomnia and sleep disorders can produce your cognitive symptoms 1:

• Idiopathic hypersomnia presents with excessive sleepiness, memory lapses, concentration problems, and automatic behavior 1
• Sleep deprivation from any cause produces cognitive fog and can worsen pain perception 1

Treatment Approach Based on Findings

If Neuropathy is Confirmed

First-line pharmacologic treatments for neuropathic pain include 2:

• Duloxetine (SNRI) - specifically recommended for neuropathic pain, numbness, and tingling 2
• Pregabalin or gabapentin (anticonvulsants) - effective for neuropathic pain 2
  • Common side effects of pregabalin include: dizziness (20.9%), somnolence (35.7%), memory impairment (3.3%), disturbance in attention (3.8%), and confusional state 7
  • Important caveat: Pregabalin itself can worsen cognitive symptoms, so careful monitoring is essential 7
• Tricyclic antidepressants - also first-line options 2

Non-Pharmacologic Interventions

Physical activity is recommended as a non-pharmacological approach for both neuropathy and cognitive symptoms 2

Addressing Underlying Causes

Treatment must target the root cause 1:

• If diabetic: Optimize glycemic control to prevent progression 1
• If B12 deficient: Supplementation can reverse symptoms if caught early 1
• If hypothyroid: Thyroid replacement therapy 1
• If medication-induced: Consider alternative medications 1

Red Flags Requiring Urgent Evaluation

Seek immediate medical attention if you develop 1:

• Asymmetric symptoms - suggests focal nerve compression or stroke rather than systemic neuropathy 2
• Rapid progression of weakness or sensory loss 1
• Bowel or bladder dysfunction - suggests spinal cord involvement 1
• Severe confusion or disorientation - may indicate acute metabolic derangement 1

Common Pitfalls to Avoid

• Do not assume diabetic neuropathy without documented diabetes - many other causes exist 1, 3
• Do not dismiss cognitive symptoms as purely psychological - they may represent neuroinflammation or metabolic dysfunction 6, 5
• Do not start symptomatic treatment without investigating underlying causes - treatable conditions may be missed 1
• Recognize that pregabalin can worsen cognitive symptoms - monitor carefully if prescribed 7

Your next step should be consultation with a physician for comprehensive evaluation including the laboratory tests and neurological examination outlined above, as early identification and treatment of underlying causes offers the best chance for symptom improvement and prevention of progression. 1, 2