Differential Diagnosis for Seizure
When a patient presents with a seizure, it's crucial to consider a wide range of potential causes to ensure appropriate management and treatment. The differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Epilepsy: This is often the first consideration for a patient presenting with a seizure, especially if there's a known history of epilepsy. Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures.
Other Likely Diagnoses
- Metabolic disorders (e.g., hypoglycemia, hyponatremia, hypocalcemia): Various metabolic imbalances can precipitate seizures in susceptible individuals.
- Head trauma: Traumatic brain injuries can cause seizures, either immediately after the injury or as a delayed complication.
- Infections (e.g., meningitis, encephalitis): Central nervous system infections can lead to seizures due to inflammation and disruption of normal brain function.
- Stroke or transient ischemic attack (TIA): Both ischemic and hemorrhagic strokes can cause seizures, although this is less common.
- Brain tumors: Tumors, whether primary or metastatic, can irritate the surrounding brain tissue and lead to seizures.
Do Not Miss Diagnoses
- Status epilepticus: A life-threatening condition where a seizure lasts more than 5 minutes or two or more seizures occur between which the patient doesn't return to baseline consciousness.
- Subarachnoid hemorrhage: A type of stroke caused by bleeding into the space surrounding the brain, which can present with a seizure as an initial symptom.
- Meningitis or encephalitis due to unusual pathogens (e.g., herpes simplex virus): These infections require prompt and specific treatment to prevent serious complications or death.
- Hypertensive encephalopathy: Severely elevated blood pressure can lead to brain edema and seizures.
Rare Diagnoses
- Autoimmune encephalitis: A group of conditions where the immune system attacks the brain, leading to inflammation and seizures.
- Mitochondrial disorders: Genetic conditions affecting the mitochondria, which can cause a variety of neurological symptoms including seizures.
- Porphyrias: A group of rare genetic disorders that can cause neurological symptoms, including seizures, due to defects in heme biosynthesis.
- Hashimoto's encephalopathy: A rare condition associated with Hashimoto's thyroiditis, characterized by seizures, confusion, and altered mental status.