Differential Diagnosis for a 17-year-old boy with headache, vomiting, and persistent cavum vergae on NCCT head
- Single most likely diagnosis
- Idiopathic enlargement of the subarachnoid space or benign external hydrocephalus: This condition is characterized by an enlargement of the subarachnoid spaces, which can include the cavum vergae, often seen in children and young adults. Symptoms can include headache and vomiting, which align with the patient's presentation.
- Other Likely diagnoses
- Hydrocephalus: The presence of a persistent cavum vergae, along with symptoms of increased intracranial pressure such as headache and vomiting, could suggest hydrocephalus. This condition involves an accumulation of cerebrospinal fluid (CSF) within the brain, leading to increased pressure.
- Brain tumor: Although less common, a brain tumor could cause obstructive hydrocephalus, leading to an enlargement of the ventricular system, including the cavum vergae. Symptoms would depend on the tumor's location and size but could include headache and vomiting.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Intracranial hemorrhage or stroke: Although the NCCT head might not initially suggest a hemorrhage, especially if it's a small or chronic bleed, or if the patient has had a stroke, these conditions require immediate attention. Symptoms like headache and vomiting could be indicative of increased intracranial pressure due to a hemorrhage or stroke.
- Meningitis or encephalitis: Infections of the meninges or brain tissue can cause symptoms similar to those presented, including headache and vomiting. These conditions are medical emergencies and require prompt diagnosis and treatment.
- Rare diagnoses
- Dandy-Walker malformation: This is a rare congenital disorder characterized by an enlargement of the fourth ventricle and hypoplasia of the cerebellar vermis. While it typically presents in infancy, some cases might not become apparent until later in childhood or adolescence, potentially causing symptoms like headache and vomiting due to hydrocephalus.
- Vein of Galen malformation: A rare congenital arteriovenous malformation that can cause hydrocephalus and increased intracranial pressure, leading to symptoms such as headache and vomiting. It is usually diagnosed in infancy but can occasionally present later.