Differential Diagnosis for Persistent Memory Issues
The patient's presentation of persistent memory issues, combined with a significant neurological history, requires a comprehensive differential diagnosis. The following categories outline potential causes for her symptoms:
- Single Most Likely Diagnosis
- Seizure Disorder: The patient's history of seizure disorder, recent episodes of "eyes rolling back in her head," and lack of current seizure medication suggest that her seizure disorder may not be well-controlled, potentially contributing to her memory issues.
- Other Likely Diagnoses
- Medication Side Effects: The patient is taking several medications that can affect memory, such as Buspirone, Gabapentin, Risperidone, Duloxetine, Tizanidine, and Ropinirole. Although she is reluctant to adjust these medications, their potential impact on her memory cannot be ignored.
- Post-Concussive Syndrome: The patient's childhood brain injury could be contributing to her ongoing memory issues, especially given the lack of follow-up care in recent years.
- Depression or Anxiety: The patient's history of taking medications like Buspirone, Duloxetine, and Risperidone suggests that she may have a history of depression or anxiety, which can also affect memory.
- Do Not Miss Diagnoses
- Brain Tumor: Although less likely, a brain tumor could be causing the patient's memory issues and seizures. Imaging studies, such as the ordered CT head, are crucial to rule out this potentially life-threatening condition.
- Vascular Disease: The carotid ultrasound is important to assess for vascular disease, which could be contributing to the patient's memory issues and seizures.
- Infection or Encephalitis: Although the patient denies symptoms like headaches or fever, an infectious cause like encephalitis could be present and requires prompt diagnosis and treatment.
- Rare Diagnoses
- Neurodegenerative Disease: Conditions like frontotemporal dementia or Alzheimer's disease are less likely given the patient's age and presentation, but cannot be entirely ruled out without further evaluation.
- Mitochondrial Disease: The patient's history of childhood brain injury and seizure disorder could be related to a mitochondrial disease, although this is a rare and less likely possibility.