Differential Diagnosis
- Single most likely diagnosis
- Subarachnoid hemorrhage (SAH) with subsequent acute respiratory distress syndrome (ARDS): The patient's history of sudden onset giddiness, fall, altered sensorium, and hemorrhagic tap on lumbar puncture strongly suggests SAH. The severe breathlessness, respiratory distress, and bilateral alveolar opacifications are consistent with ARDS, which can be a complication of SAH.
- Other Likely diagnoses
- Status epilepticus with respiratory failure: The patient's history of seizure and defaulting on medication increases the risk of status epilepticus, which can cause altered sensorium, respiratory distress, and hypotension.
- Septic shock with respiratory failure: The patient's hypotension, requiring noradrenaline to maintain MAP, and respiratory distress could be indicative of septic shock, although there is no clear source of infection mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Traumatic brain injury: Although the NCCT brain is normal, a repeat CT or MRI may be necessary to rule out traumatic brain injury, especially given the patient's history of fall.
- Meningitis or encephalitis: The patient's altered sensorium, seizure history, and hemorrhagic tap could be indicative of meningitis or encephalitis, which would require prompt antibiotic or antiviral treatment.
- Pulmonary embolism: The patient's severe respiratory distress and hypotension could be indicative of a pulmonary embolism, which would require prompt anticoagulation.
- Rare diagnoses
- Cerebral vasculitis: The patient's SAH and hemorrhagic tap could be indicative of cerebral vasculitis, although this is a rare condition.
- Mitochondrial disorders: The patient's history of seizure and respiratory distress could be indicative of a mitochondrial disorder, such as MELAS syndrome, although this is a rare condition.