Differential Diagnosis for a 30-year-old Male with Sudden Nausea, Vomiting, Dizziness, and Headache
Single most likely diagnosis
- Viral Gastroenteritis: This condition is characterized by the sudden onset of nausea, vomiting, and dizziness, which matches the patient's symptoms. The normal lab results and the presence of an inverted T wave on the ECG, which can be a non-specific finding, do not strongly point away from this diagnosis.
Other Likely diagnoses
- Migraine: Migraines can cause nausea, vomiting, dizziness, and headache. The inverted T wave on the ECG could be a non-specific finding or related to stress or other factors.
- Benign Paroxysmal Positional Vertigo (BPPV): This condition causes dizziness and nausea, especially with changes in head position. However, it typically does not cause vomiting or headache as prominent symptoms.
- Anxiety or Panic Attack: These can cause a wide range of symptoms including nausea, vomiting, dizziness, and headache, along with anxiety or fear. The inverted T wave could be related to stress.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Myocardial Infarction (MI): Although less common in a 30-year-old male, an MI can present with atypical symptoms such as nausea, vomiting, and dizziness. The inverted T wave on the ECG is a red flag that necessitates further cardiac evaluation.
- Subarachnoid Hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") can be accompanied by nausea, vomiting, and dizziness. Normal initial labs do not rule out this diagnosis.
- Pulmonary Embolism: Can present with sudden onset of symptoms like dizziness and nausea, especially if there is associated hypoxia or anxiety. The headache could be due to hypoxia or stress.
Rare diagnoses
- Meniere's Disease: An inner ear disorder that affects balance and hearing, causing episodes of vertigo, nausea, vomiting, and headache. It's less likely given the acute presentation and lack of hearing symptoms.
- Cyclic Vomiting Syndrome: Characterized by recurrent episodes of severe vomiting, often with no apparent cause. It's rare and typically has a more chronic course.
- Chiari Malformation: A structural defect in the cerebellum that can cause a range of symptoms including headache, nausea, vomiting, and dizziness, especially with coughing or straining. It's a rare condition that might not be initially suspected.