Differential Diagnosis for Transient Visual Loss and Blurring
Single Most Likely Diagnosis
- Migraine variant: Given the patient's history of migraines and the transient nature of the visual symptoms without any persistent headache, a migraine variant is the most likely diagnosis. The visual blurring and bilateral peripheral field loss are consistent with migraine-related visual disturbances.
Other Likely Diagnoses
- Concussive injury: Although the patient does not recall any loss of consciousness, the mechanism of injury (tripping and landing hard on the upper torso) could have caused a concussive injury, leading to transient visual symptoms.
- Post-traumatic migraine: Similar to a migraine variant, but specifically triggered by the traumatic event. The absence of headache does not rule out this diagnosis, as post-traumatic migraines can present with varied symptoms.
Do Not Miss Diagnoses
- Intracranial hemorrhage: Although less likely given the lack of severe headache, vomiting, or loss of consciousness, an intracranial hemorrhage (e.g., subdural or epidural hematoma) could present with transient visual disturbances. This diagnosis is critical to rule out due to its potential severity and need for urgent intervention.
- Cervical spine injury: Despite the patient's denial of neck pain, a cervical spine injury could potentially cause visual disturbances due to vertebral artery dissection or other mechanisms. This diagnosis is crucial to consider due to the risk of spinal cord injury.
Rare Diagnoses
- Occipital lobe contusion: A direct injury to the occipital lobe could result in visual field defects, although this would be less likely without other symptoms such as headache or loss of consciousness.
- Vertebral artery dissection: This is a rare but potentially serious condition that could cause visual disturbances due to ischemia in the posterior circulation. It is more commonly associated with neck pain or trauma, but can occasionally present without these symptoms.