Differential Diagnosis
The patient presents with a 24-hour history of increased tiredness, confusion, weakness, fever, headache, and myalgias. The following differential diagnoses are considered:
- Single most likely diagnosis
- Guillain-Barré syndrome: This is the most likely diagnosis, given the patient's rapid progression of weakness from the feet to the legs, areflexia, and the absence of sensory deficits. The patient's symptoms, such as fever, headache, and myalgias, are also consistent with a post-infectious etiology, which is common in Guillain-Barré syndrome.
- Other Likely diagnoses
- West Nile meningoencephalitis: This diagnosis is possible, given the patient's fever, headache, and myalgias, which are consistent with a viral infection. However, the patient's primary complaint of weakness and areflexia is more suggestive of Guillain-Barré syndrome.
- Transverse myelitis: This diagnosis is also possible, given the patient's weakness, areflexia, and sensory intactness. However, the patient's symptoms are more suggestive of a peripheral neuropathy, such as Guillain-Barré syndrome, rather than a spinal cord lesion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epidural abscess: Although this diagnosis is less likely, given the patient's lack of back pain and the absence of a clear source of infection, it is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses
- HIV-associated vacuolar myelopathy: This diagnosis is unlikely, given the patient's lack of risk factors for HIV infection and the absence of other symptoms suggestive of HIV disease. However, it is a possible consideration in patients with unexplained neurological symptoms.