Differential Diagnosis
The patient's symptoms of frequent falls, emotional changes, memory and concentration difficulties, restricted gaze, limited facial movements, and increased axial muscle tone suggest a neurodegenerative disorder. Here is the differential diagnosis:
Single most likely diagnosis
- F) Progressive supranuclear palsy: This diagnosis is most likely due to the patient's severely restricted voluntary downward and lateral gaze, which is a hallmark of progressive supranuclear palsy. The patient's other symptoms, such as difficulty with emotional regulation, memory and concentration problems, limited facial movements, and increased axial muscle tone, are also consistent with this diagnosis.
Other Likely diagnoses
- E) Parkinson disease: While Parkinson disease can cause restricted gaze, increased muscle tone, and decreased movement, the patient's severely restricted downward and lateral gaze is more suggestive of progressive supranuclear palsy. However, Parkinson disease is still a possible diagnosis.
- C) Huntington disease: Huntington disease can cause emotional changes, memory and concentration problems, and movement difficulties, but the patient's restricted gaze and increased axial muscle tone are not typical of this condition.
Do Not Miss
- B) Hepatolenticular degeneration (Wilson disease): Although Wilson disease is rare, it can cause neurological symptoms, including movement difficulties and emotional changes. If left untreated, Wilson disease can be fatal, making it a "do not miss" diagnosis.
- D) Myasthenia gravis: Myasthenia gravis is an autoimmune disorder that can cause muscle weakness and fatigue, but it does not typically cause restricted gaze or increased axial muscle tone. However, myasthenia gravis can cause respiratory failure if left untreated, making it a "do not miss" diagnosis.
Rare diagnoses
- A) Dementia, Alzheimer type: While Alzheimer disease can cause memory and concentration problems, it does not typically cause restricted gaze or increased axial muscle tone.
- Other rare diagnoses, such as multiple system atrophy or corticobasal degeneration, may also be considered, but they are less likely given the patient's specific symptoms.