For my OBGYN rotation, I had the opportunity of presenting my patient cases to Professor Melendez. Out of the cases I presented, I found the pregnant woman with dizziness, numbness and tingling to be the most interesting. She was a 26-year-old female G3P1011 at 31w5d gestational age with a history of bariatric surgery who presented with dizziness, numbness and tingling in bilateral upper and lower extremities for 1 week. She reported the episodes only occurred during the day and lasted a few hours and then resolved spontaneously without intervention. She stated she had never experienced this sensation before in the past. She also noted the dizziness was intermittent and lasted less than 1 min and resolved spontaneously. She denied new sexual partners, fever, chills, nausea, vomiting, diarrhea, heavy bleeding, loss of fluid, chest pain, SOB, weakness, recent sick contacts, recent travel, headache, or focal deficits. 

My initial differential diagnoses based on this history were vitamin b12 deficiency, peripheral neuropathy, preeclampsia.

On exam, patient’s vitals were stable, and patient was afebrile. The physical exam was unremarkable. A neurology consult was also obtained which was unremarkable.

Labs that were ordered but not finalized included a CBC, CMP, UA and urine culture, Ferritin, TBIC, Hemoglobin A1c, vaginitis panel, Gonorrhea and Chlamydia, magnesium, vitamin D, folate, and Vitamin B12. 

Based on the patient’s history and physical exam findings, my leading differential was nutritional deficiency, most likely Vitamin B12.