Numbness and tingling

Numbness (loss of sensation) and tingling (paraesthesia) signal that a sensory nerve is malfunctioning at some point between the skin and the brain. Distribution is the master diagnostic clue: classic 'stocking-glove' (both hands and feet) suggests polyneuropathy — diabetic, alcohol-related, B12-deficient, chemotherapy-induced; a single dermatome points to nerve-root compression (sciatica, cervical radiculopathy); hand-only at night fits carpal tunnel syndrome; face + arm in a sudden pattern is a stroke until proven otherwise. Severity and pace also matter — sudden onset is more dangerous than slowly progressive.

• Diabetic peripheral neuropathy — most common cause of stocking-glove pattern globally.
• Vitamin B12 deficiency — subacute combined degeneration; reversible if caught early.
• Carpal tunnel syndrome — nocturnal thumb-index-middle finger paraesthesia, common in pregnancy, hypothyroidism, repetitive hand work.
• Cervical or lumbar radiculopathy — dermatomal pattern, often with neck or back pain.
• Multiple sclerosis — younger patient, episodic, accompanying visual or motor symptoms.
• Stroke or TIA — sudden onset, usually one-sided, with weakness or speech change.
• Hypocalcaemia, hypomagnesaemia — peri-oral and finger-tip tingling.
• Hypothyroidism — slow distal sensory loss; reversible with thyroxine.
• Chemotherapy-induced neuropathy — platinum-based and taxane agents.
• Alcohol-related neuropathy.

Standard panel: HbA1c and fasting glucose (diabetes), vitamin B12 and folate, TSH, calcium and magnesium, electrolytes, CBC (anaemia → B12 macrocytic pattern), and LFTs if alcohol-related neuropathy suspected. Homocysteine and methylmalonic acid add specificity for early B12 deficiency. Mediora.AI surfaces the B12 + glucose + thyroid pattern; nerve-conduction studies and neurology referral are clinic-driven decisions.