[45F] Experiencing paresthesia, night sweats, and other symptoms

Paresthesia in legs

Differential diagnosis

• Given the patient's history of restless leg syndrome, the paresthesia could be related (G25.81)
• Other possibilities include peripheral neuropathy (G62.9), multiple sclerosis (G35), and vitamin B12 deficiency (E53.8)

Plan

Perform a neurological exam and consider ordering nerve conduction studies. Check vitamin B12 levels. If symptoms persist or worsen, consider referral to a neurologist.

Night sweats, fatigue, unexpected weight loss

Differential diagnosis

• These symptoms could be indicative of a systemic issue such as malignancy (C80.1), tuberculosis (A15.9), or HIV (B20)
• Other possibilities include hyperthyroidism (E05.90), menopause (N95.1), and lymphoma (C85.90)

Plan

Order a complete blood count, thyroid function tests, and chest X-ray. Consider HIV and TB testing based on risk factors. If symptoms persist or worsen, consider referral to an endocrinologist or oncologist.

Balance issues, dizziness

Differential diagnosis

• Possible causes include benign paroxysmal positional vertigo (H81.1), Meniere's disease (H81.0), and vestibular neuritis (H81.2)
• Other possibilities include cerebellar disorders (G11.9), multiple sclerosis (G35), and stroke (I63.9)

Plan

Perform a neurological exam and consider ordering imaging studies such as a CT or MRI of the brain. If symptoms persist or worsen, consider referral to a neurologist or otolaryngologist.

Headaches

Differential diagnosis

• Possible causes include tension headache (G44.2), migraine (G43.9), and cluster headache (G44.0)
• Other possibilities include brain tumor (C71.9), sinusitis (J32.9), and medication overuse headache (G44.41)

Plan

Perform a neurological exam and consider ordering imaging studies such as a CT or MRI of the brain. If symptoms persist or worsen, consider referral to a neurologist.

Nausea, diarrhea

Differential diagnosis

• Possible causes include gastroenteritis (K52.9), irritable bowel syndrome (K58.9), and food intolerance (K90.89)
• Other possibilities include celiac disease (K90.0), inflammatory bowel disease (K50.90), and gastrointestinal malignancy (C26.9)

Plan

Order a complete blood count, stool studies, and consider ordering a colonoscopy. If symptoms persist or worsen, consider referral to a gastroenterologist.