Left Hand Numbness and Pulsatile Tinnitus: A Medical Inquiry - Neurology

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Your inquiry regarding the left hand numbness and pulsatile tinnitus raises several important medical considerations. Based on the symptoms you've described, including the numbness in your left hand, the pulsatile tinnitus, and the various tests you've undergone, it seems that there may be multiple factors at play.

Firstly, the numbness in your left hand, particularly if it is accompanied by a lack of sensation when applying pressure to your fingers, could suggest a neurological issue. Given your history of autonomic nervous system dysregulation and previous evaluations by neurologists, it would be prudent to consider a few potential causes. One possibility is a compression of the nerves in the cervical spine (neck area), which can lead to symptoms in the arms and hands. This could be due to cervical radiculopathy, where a nerve root is compressed, often by a herniated disc or degenerative changes in the spine. An MRI of the cervical spine could help identify any such issues.

Additionally, the fact that you experience these symptoms at night could suggest a positional component, where certain sleeping positions may exacerbate nerve compression. It might be beneficial to evaluate your sleeping posture and consider using supportive pillows to maintain proper alignment of your neck and spine.

Regarding the pulsatile tinnitus, which you've noted occurs primarily at night, this condition can sometimes be related to vascular issues, such as increased blood flow or vascular malformations near the ear. However, since you've mentioned that multiple ear specialists have found no significant issues, it may be worth exploring other potential causes. Stress and anxiety can also exacerbate tinnitus, and given your history of panic attacks and anxiety, this could be a contributing factor. Cognitive behavioral therapy or other forms of psychological support might be beneficial in managing these symptoms.

The blood pressure readings you've provided indicate some variability, particularly in your left arm. While these readings alone may not be alarming, they could suggest a need for further cardiovascular evaluation, especially if you have a history of anxiety and panic attacks, which can sometimes lead to transient changes in blood pressure.

Your mention of experiencing leg numbness and the sensation of your body "protesting" due to lack of sleep is also noteworthy. Chronic sleep deprivation can lead to a variety of neurological symptoms, including numbness and tingling, as well as exacerbating anxiety and panic symptoms. Improving your sleep hygiene, such as establishing a regular sleep schedule, reducing caffeine intake, and creating a calming bedtime routine, may help alleviate some of these symptoms.

In summary, your symptoms of left hand numbness and pulsatile tinnitus could be multifactorial, involving neurological, vascular, and psychological components. It would be advisable to follow up with a neurologist for a comprehensive evaluation, including imaging studies if necessary, and to consider a multidisciplinary approach that includes psychological support for anxiety management. Additionally, addressing lifestyle factors such as sleep quality and posture may also contribute positively to your overall well-being.