Differential Diagnosis for 14-Year-Old Female Patient
Single Most Likely Diagnosis
- Migraine with aura: The patient's symptoms of sudden onset headache, eye pain, numbness in the arms (which switched sides), nausea, vomiting, and visual disturbances are consistent with a migraine with aura. The changing nature of the numbness and the bilateral headache also support this diagnosis.
Other Likely Diagnoses
- Tension headache: Although less likely given the visual disturbances and numbness, tension headaches can cause bilateral headaches and nausea.
- Cluster headache: The severe, one-sided headache and eye pain could suggest a cluster headache, but the switching of numbness and the bilateral nature of the headache later on make this less likely.
- Viral illness: A viral illness could cause headache, nausea, vomiting, and fatigue, but the specific pattern of numbness and visual disturbances makes this less likely.
Do Not Miss Diagnoses
- Stroke or transient ischemic attack (TIA): Although rare in a 14-year-old, a stroke or TIA could cause sudden onset headache, numbness, and visual disturbances. It is crucial to rule out these conditions due to their severe consequences.
- Subarachnoid hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") could indicate a subarachnoid hemorrhage, which is a medical emergency.
- Meningitis: Infection of the meninges could cause headache, nausea, vomiting, and visual disturbances, along with fever and stiff neck, which are not mentioned but should be considered.
Rare Diagnoses
- Multiple sclerosis: This condition could cause numbness, visual disturbances, and headaches, but it is relatively rare in adolescents and would typically involve more widespread neurological symptoms.
- Arteriovenous malformation (AVM): An AVM could cause headaches, numbness, and visual disturbances due to abnormal blood vessel formation in the brain, but this is a rare condition.
- Idiopathic intracranial hypertension: This condition, also known as pseudotumor cerebri, could cause headaches, visual disturbances, and nausea, but it is relatively rare and often associated with other symptoms like papilledema.