Differential Diagnosis for Intermittent Bilateral Visual Loss
- Single most likely diagnosis
- Panic attack: The patient's symptoms of intermittent bilateral visual loss, racing heartbeat, and feeling of traveling through a tunnel are consistent with a panic attack. The normal examination results, including routine non-dilated funduscopic and neurologic examinations, also support this diagnosis.
- Other Likely diagnoses
- Basilar migraine: This condition can cause visual symptoms, including bilateral visual loss, as well as other symptoms such as tinnitus, vertigo, and paresthesias. However, the patient's symptoms are not as typical for basilar migraine, which often includes headache and other neurological symptoms.
- Amaurosis fugax: This condition is characterized by transient, unilateral visual loss, but it can occasionally be bilateral. However, the patient's symptoms of racing heartbeat and tunnel vision are not typical for amaurosis fugax.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Retinal detachment: Although the patient's examination results are normal, retinal detachment can cause sudden, painless visual loss and is a medical emergency. A dilated funduscopic examination would be necessary to rule out this condition.
- Optic neuritis: This condition can cause visual loss, pain, and other symptoms, and can be a sign of multiple sclerosis or other underlying conditions. Although the patient's examination results are normal, optic neuritis should be considered and further evaluation, such as MRI, may be necessary.
- Rare diagnoses
- Somatic symptom disorder: This condition is characterized by one or more chronic physical symptoms that are distressing and result in significant disruption of daily life. However, the patient's symptoms are acute and do not suggest a chronic condition.
- Other rare conditions, such as vertebrobasilar insufficiency or migraine with aura, could also be considered, but are less likely given the patient's symptoms and normal examination results.