Differential Diagnosis
- Single most likely diagnosis
- B) Glioblastoma multiforme: This is the most likely diagnosis due to the progressive nature of the headaches, worsening with Valsalva maneuver, and associated with vomiting, which suggests increased intracranial pressure. The episode of left arm and face jerking could indicate a seizure, which is common in brain tumors. The presence of bilateral papilledema, left pronator drift, left-sided hyperreflexia, and Babinski sign on the left also points towards a space-occupying lesion in the brain, such as a glioblastoma multiforme.
- Other Likely diagnoses
- E) Intracerebral hemorrhage: Although less likely than glioblastoma, an intracerebral hemorrhage could present with sudden onset of headache, vomiting, and focal neurological deficits. However, the progressive nature of the symptoms over 2 months makes this less likely.
- D) Idiopathic intracranial hypertension: This condition could explain the headaches, vomiting, and bilateral papilledema. However, the presence of focal neurological deficits (left pronator drift, left-sided hyperreflexia, and Babinski sign) and the episode of jerking are not typical for idiopathic intracranial hypertension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- A) Cerebral infarction: Although the symptoms have been progressive over 2 months, it's essential to consider the possibility of a cerebral infarction, especially given the presence of focal neurological deficits. A CT scan of the head is pending, which will help to rule out this diagnosis.
- C) Hypertensive encephalopathy: Given the patient's elevated blood pressure (150/90 mm Hg), hypertensive encephalopathy is a possibility, although the presence of focal neurological deficits and the episode of jerking are not typical for this condition.
- Rare diagnoses
- Other rare diagnoses, such as brain abscess or cerebral venous sinus thrombosis, could also be considered, but they are less likely given the information provided. A brain abscess might present with fever, which is not present in this case (temperature 37.0°C or 98.6°F), and cerebral venous sinus thrombosis might present with more prominent symptoms of increased intracranial pressure and possibly seizures, but the focal neurological deficits would be less typical.