Brief Answer:
Requires Neurological evaluation

Detailed Answer:

Hi,

As a neurologist if another patient were to arrive at my office with this type of complaint in my office I would be concerned about 2 major things which I would work on immediately.

1. Sensory TIA (mini-stroke) which could be transiently and intermittently affecting the RIGHT circulatory system of the brain with possible problems in the VERTEBROBASILAR ARTERY (VBA), the POSTERIOR CEREBRAL ARTERY, or the perforating smaller arterial branches that supply the thalamus (choroidal arteries/thalamo perforators)

2. Because of your high daily consumption of liquor you are at increased risk for ATRIAL FIBRILLATION which can lead to the development of blood clots in the heart that then, could be ejected into small fragments into the posterior circulation being carried into the posterior fossa circulation and finally into the RIGHT thalamus which can lead to the focal paresthesias you are describing.

3. Alternatively to this theory could be affectation of the frontoparietal region of the RIGHT cerebral hemisphere in a place called BRODMANN's somesthetic cortex which could theoretically also give similar symptoms except now this route of circulatory travel would involve the RIGHT CAROTID artery, RIGHT MIDDLE CEREBRAL ARTERY (MCA), and/or ANTERIOR CEREBRAL ARTERY, and and finally the penetrators of the somesthetic cortex responsible to sensation in the body areas you describe.

4. Another important set of considerations to take into account and which I would workup at the first visit to my office would be metabolic and biochemical markers and factors which when in low or short supply are known to cause feelings of numbness and tingling of body parts...although when this is the source of problem it tends not to be such a FOCAL problem (i.e. LEFT SIDE only) and is more diffuse or generalized and you're not describing this...But at any rate, I would definitely order labs having to do with the onset of PARESTHESIAS such as Vitamin B12, Vitamin B6, Vitamin B1, Vitamin D, Thyroid function tests to include FT4 and TSH, as well as inflammatory markers such as ESR and CRP, and of course, renal studies which include Creatinine, BUN, and what we call an EGFR (estimated glomerular filtration rate).

5. I would also get a cardiology consult in order to help rule out a cardiac process which would likely include tests such as an EKG, 2D echo with BUBBLE study (ruling out a defect in the cardiac wall known as a PATENT FORAMEN OVALE (PFO), Holter Monitor for 30 days to rule out ATRIAL FIBRILLATION (high risk for having due to alcohol consumption statistics), and a TEE (transesophageal echocardiogram). Here we are looking for small attached THROMBI to the left atrial appendage for the most part in the heart that could be flicking off debris up the VBA.

6. If everything in this suggested workup came out pristine and clear of any poor circulation in the brain or defects of function in the heart then, in my opinion there may be a little more opportunity to sit down and study the picture more in-depth and try to find additional angles to attack the symptoms.

If I've adequately answered your questions then, I'd greatly appreciate your CLOSING the query to this encounter keeping in mind that I am happy to answer more questions regarding this or any other case of medical interest. Cheers!

29 minutes of professional time were spent in reading, researching, and formulating an analysis on behalf of this patient.

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