Differential Diagnosis for Enuresis in an 8-year-old Girl
Single Most Likely Diagnosis
- Sleep Apnea: The patient's symptoms of snoring loudly, moving around a lot during sleep, and excessive daytime sleepiness (as evidenced by 2-hour naps after school) are highly suggestive of obstructive sleep apnea (OSA). Tonsillar hypertrophy is a common cause of OSA in children, which can lead to enuresis due to increased nocturnal urine production and decreased arousal from sleep.
Other Likely Diagnoses
- Constipation: Although not directly mentioned, constipation is a common cause of enuresis in children. It can lead to urinary retention and subsequent overflow incontinence.
- Neurogenic Bladder: A neurogenic bladder can cause enuresis, but the absence of daytime incontinence and other neurological symptoms makes this less likely.
- Urinary Tract Infection (UTI): Although the urinalysis is unremarkable, a UTI could still be present and cause enuresis. However, the lack of other symptoms such as dysuria or abdominal pain makes this less likely.
Do Not Miss Diagnoses
- Diabetes Mellitus: C. Ketoacidosis is a potential complication of untreated diabetes mellitus, which can cause enuresis. Although the patient's symptoms do not strongly suggest diabetes, it is essential to consider this diagnosis due to the potential severity of ketoacidosis.
- Spinal Cord Lesions: Although rare, spinal cord lesions can cause neurogenic bladder and enuresis. The absence of other neurological symptoms makes this less likely, but it is crucial to consider due to the potential severity of spinal cord lesions.
Rare Diagnoses
- Aspiration Pneumonia (A): This is unlikely to be directly related to the patient's enuresis, but it could be a complication of gastroesophageal reflux disease (GERD), which can coexist with OSA.
- Internuclear Ophthalmoplegia (B): This is a rare condition that can cause double vision and is often associated with multiple sclerosis or stroke. It is unlikely to be related to the patient's enuresis.
- Pyelonephritis (D): This is a rare complication of UTI, but it is unlikely to be the primary cause of the patient's enuresis.
- Systemic Hypertension (E): Although OSA can increase the risk of systemic hypertension, this is unlikely to be the primary cause of the patient's enuresis.