Differential Diagnosis for a Three-Year-Old Female with Recurrent Episodes of Headache and Leg Weakness
Single Most Likely Diagnosis
- Post-Traumatic Migraine: This condition is a strong consideration given the patient's history of mild head trauma followed by episodes of headache, nausea, vomiting, sensitivity to light and sound, and leg weakness. The symptoms align closely with migraine characteristics, which can be triggered by head trauma.
Other Likely Diagnoses
- Post-Concussive Syndrome: Similar to post-traumatic migraine, this condition follows a head injury and can include symptoms such as headache, nausea, vomiting, and sensitivity to light and noise. The leg weakness could be related to the concussion's impact on the brain.
- Hydrocephalus: Although less common, hydrocephalus could be a consideration, especially if the head trauma led to an accumulation of cerebrospinal fluid in the brain, causing increased intracranial pressure. Symptoms can include headache, nausea, vomiting, and in severe cases, weakness.
- Intracranial Hemorrhage or Hematoma: While the trauma was described as mild, the possibility of a small bleed or hematoma cannot be entirely ruled out, especially if the patient has a coagulopathy or is on anticoagulant therapy. Symptoms can include headache, vomiting, and focal neurological deficits like leg weakness.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely with mild trauma, a subarachnoid hemorrhage is a critical diagnosis to consider due to its high morbidity and mortality. It presents with sudden, severe headache (often described as "the worst headache of my life"), and can be accompanied by nausea, vomiting, and sensitivity to light.
- Brain Tumor: While rare in this context, a brain tumor could cause increased intracranial pressure leading to headaches, nausea, vomiting, and focal neurological signs like leg weakness. The history of uterine growth restriction and small gestational age might suggest a potential for developmental abnormalities.
- Arteriovenous Malformation (AVM): An AVM could bleed after minor trauma, leading to symptoms such as headache, vomiting, and focal neurological deficits. Given the patient's past medical history, there might be a slight increased risk for vascular malformations.
Rare Diagnoses
- Mitochondrial Disorders: Conditions like MELAS syndrome (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes) could present with recurrent episodes of headache, nausea, vomiting, and stroke-like episodes, including leg weakness. The patient's history of growth restriction and small gestational age might hint at a possible underlying metabolic or genetic condition.
- Vasculitis: Rare inflammatory conditions affecting the blood vessels in the brain could lead to symptoms similar to those described. However, these conditions are uncommon in children and would typically be associated with other systemic symptoms.
- Chiari Malformation: This condition involves a structural defect in the cerebellum that controls balance and can cause headaches, nausea, vomiting, and weakness, especially after trauma. However, it's less likely without other symptoms such as neck pain or arm weakness.