What could be causing tingling and numbness all over my body?

Tingling and Numbness All Over Body: Diagnostic and Management Approach

Immediate Life-Threatening Causes Must Be Ruled Out First

You must immediately assess for Guillain-Barré Syndrome (GBS) and cervical spinal cord pathology, as these conditions can rapidly progress to respiratory failure and permanent neurological damage. 1, 2

Critical Red Flags Requiring Emergency Evaluation

• Rapidly progressive weakness ascending from legs to arms with bilateral paresthesias indicates possible GBS, which causes respiratory failure requiring mechanical ventilation in 20% of patients 2
• Absent or diminished reflexes (areflexia/hyporeflexia) throughout the body strongly suggests GBS 2
• Declining respiratory function measured by vital capacity and negative inspiratory force 2
• Autonomic dysfunction including blood pressure instability, cardiac arrhythmias, or bowel/bladder dysfunction 1, 2
• Recent infection within 6 weeks (Campylobacter jejuni, CMV, Hepatitis E, Mycoplasma, EBV, or Zika) supports GBS diagnosis 2

Emergency Actions for Suspected GBS

• Admit immediately to monitored setting with respiratory monitoring capability 2
• Order urgent MRI of entire spine without and with contrast to exclude cord compression or transverse myelitis 1, 2
• Perform CSF analysis including cell count, protein, glucose, and oligoclonal bands (increased protein with normal cell count supports GBS) 2
• Initiate treatment urgently with IVIG 2 g/kg over 5 days or plasmapheresis if GBS is confirmed 2

Spinal Cord Pathology Assessment

• Check for upper motor neuron signs including hyperreflexia, clonus, and extensor plantar responses, which indicate cervical cord involvement 2
• Assess lower extremity involvement - if present with bilateral hand symptoms, this strongly suggests central cord pathology 2
• Look for burning dysesthesias in forearms, which suggest central cord syndrome 2
• Obtain immediate neurosurgical consultation if cord pathology is suspected 1

Risk Factors for Spinal Injury

The American Heart Association identifies specific high-risk criteria that mandate spinal motion restriction: 1

• Age ≥65 years 1
• Motor vehicle or bicycle crash 1
• Fall from greater than standing height 1
• Sensory deficit or muscle weakness involving the torso or upper extremities 1
• Not fully alert or intoxicated 1
• Other painful injuries, especially of head and neck 1

If any of these risk factors are present, manually stabilize the head to minimize motion of head, neck, and spine until definitive imaging excludes injury. 1 Do not use immobilization devices unless properly trained, as they may cause harm 1.

Secondary Differential Diagnoses for Generalized Numbness

Diabetic Peripheral Neuropathy

• Presents with symmetric "stocking-glove" distribution affecting distal extremities first, but can extend proximally to involve the torso in severe cases 1, 2
• Test temperature/pinprick sensation and vibration with a 128-Hz tuning fork 2
• Perform complete neurologic evaluation including temperature sensation, pinprick sensation, vibration perception, pressure sensation, and ankle reflexes 2

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

• Occurs in 30-40% of patients after taxane-based or platinum-based chemotherapy 2
• Presents in symmetric "stocking-glove" distribution affecting fingers and toes bilaterally 3, 2
• Sensory symptoms appear earlier than pain 3

Uremic Neuropathy

• Check creatinine, eGFR, and urinalysis 2

Hepatitis C-Related Neuropathy

• Occurs in up to 50% of HCV-infected patients 2
• Most common symptoms include sensory loss, paresthesias, numbness, cramps, burning feet, and tingling 2

Vitamin B12 Deficiency

• Can cause polyneuropathy with acroparesthesia 4

Monoclonal Gammopathy of Undetermined Significance

• Can present with distal symmetric polyneuropathy 4

Diagnostic Algorithm

Step 1: Assess for progressive weakness and respiratory function to rule out GBS 2

Step 2: Examine for upper motor neuron signs (hyperreflexia, clonus, extensor plantar responses) suggesting cord pathology 2

Step 3: Check for lower extremity involvement - if present with bilateral symptoms, strongly suggests central pathology 2

Step 4: Order MRI of entire cervical spine without and with contrast if any concern for cord pathology 1, 2

Step 5: Perform CSF analysis if GBS is suspected 2

Step 6: Check metabolic workup including HbA1c, vitamin B12, creatinine, eGFR, thyroid function, and hepatitis C serology 2, 4

Treatment Based on Diagnosis

For Confirmed or Suspected GBS

• Maintain spinal motion restriction until definitive imaging excludes injury 1
• Emergency neurosurgical consultation for cord compression requiring decompression 1
• IVIG or plasmapheresis as described above 2

For Peripheral Neuropathy

• Duloxetine is first-line pharmacologic treatment for peripheral neuropathy with numbness and tingling 2
• Offer physical activity for neuropathy symptoms 1, 2
• Acetaminophen, NSAIDs, and acupuncture can be offered for associated pain 2
• Other medications include pregabalin, gabapentin, and tricyclic antidepressants 1, 2

For Diabetic Neuropathy

• Improved glycemic control prevents progression but does not reverse neuronal loss 2
• Nerve repair agents, antioxidants, and improved microcirculation agents may be considered 2

For Thoracic Outlet Syndrome

• Conservative management initially with physical therapy and activity modification 1

Follow-Up and Monitoring

Schedule reassessment in 2-4 weeks to review laboratory results, assess response to initial interventions, and determine need for specialist referral 1. However, this applies only if emergency conditions have been excluded and the patient is stable.