Differential Diagnosis for a 17-year-old with Severe Intention Tremor

Single most likely diagnosis

• Multiple Sclerosis (MS): This is a condition that affects the central nervous system and can present with intention tremor, among other symptoms like headache and fatigue. The age of onset and the presence of these symptoms make MS a strong consideration.

Other Likely diagnoses

• Essential Tremor: Although more common in older adults, essential tremor can occur in younger individuals and is characterized by action or intention tremors. The absence of other neurological symptoms might lean towards this diagnosis.
• Wilson's Disease: An inherited disorder that leads to copper accumulation in the body, causing neurological symptoms including tremors, fatigue, and sometimes headaches. The young age of the patient and the specific symptom of intention tremor make this a plausible diagnosis.
• Friedreich's Ataxia: A genetic condition that causes progressive damage to the nervous system, resulting in symptoms such as intention tremor, fatigue, and sometimes headaches. The severity of the tremor and the presence of other symptoms could suggest this diagnosis.

Do Not Miss diagnoses

• Brain Tumor: Although less likely, a brain tumor could cause intention tremor, headache, and fatigue due to increased intracranial pressure or local effects on brain structures. Missing this diagnosis could be catastrophic.
• Cerebellar Stroke: A stroke affecting the cerebellum could present with sudden onset of intention tremor and other cerebellar signs. Given the potential for severe consequences if untreated, this must be considered.
• Infectious or Inflammatory Causes (e.g., Cerebellitis): Conditions like cerebellitis can cause acute onset of cerebellar symptoms including intention tremor. These conditions require prompt diagnosis and treatment to prevent long-term damage.

Rare diagnoses

• Spinocerebellar Ataxia (SCA): A group of autosomal dominant inherited diseases that cause progressive cerebellar ataxia, which could include intention tremor among its symptoms. The rarity and genetic nature of these conditions make them less likely but still important to consider in the differential diagnosis.
• Neurodegenerative Disorders (e.g., Ataxia-Telangiectasia): Other rare genetic disorders that affect the nervous system and could present with intention tremor, though they often come with a constellation of other symptoms and signs.