Differential Diagnosis for Metastatic Lung Cancer Patient with Dizziness, Headache, and Double Vision
- Single most likely diagnosis:
- Brain metastasis: This is a common complication in patients with metastatic lung cancer, and the symptoms presented (dizziness, headache, double vision) are consistent with increased intracranial pressure or brainstem involvement.
- Other Likely diagnoses:
- Cerebral vasculature events (stroke or TIA): Metastatic cancer can increase the risk of thrombotic events, and lung cancer is known to have a high risk of cerebral metastasis, which could lead to vascular events.
- Side effects of chemotherapy or targeted therapy: Certain treatments for lung cancer can cause neurological side effects, including dizziness and visual disturbances.
- Hypercalcemia of malignancy: Elevated calcium levels can cause neurological symptoms such as dizziness and confusion, and lung cancer is a common cause of hypercalcemia.
- Do Not Miss diagnoses:
- Brain herniation: Although less likely, brain herniation due to increased intracranial pressure from a brain metastasis or other causes is a medical emergency that requires immediate attention.
- Pituitary apoplexy: If the lung cancer has metastasized to the pituitary gland, apoplexy (sudden hemorrhage or infarction) could cause the symptoms presented, and it is a medical emergency.
- Spinal cord compression: While the symptoms do not directly suggest spinal cord involvement, it is a critical diagnosis to consider in cancer patients, as it can lead to rapid neurological deterioration.
- Rare diagnoses:
- Paraneoplastic syndromes: These are rare disorders caused by the immune response to a cancer, and they can cause a wide range of neurological symptoms, including those presented.
- Leptomeningeal metastasis: Cancer cells can spread to the meninges, causing a variety of neurological symptoms, but this is less common than brain metastasis.
- Vertebral metastasis with cervical spine instability: Although less likely to cause the specific symptoms of dizziness, headache, and double vision without other symptoms like neck pain or weakness, it is a consideration in patients with metastatic cancer.