History of Present Illness (HPI)

The patient is a 19-year-old female presenting with complaints of dizziness and episodes of passing out over the last 4 hours. She has been using ibuprofen without relief. She reports a history of similar episodes in the past and has been diagnosed with seizures, for which she has not taken medication for the past two years. She mentions having a neurologist in the Dallas area and notes that these episodes have decreased in frequency over the last couple of years. However, an event occurred yesterday, and today she feels "off."

Differential Diagnosis

• Single Most Likely Diagnosis
  • Seizure: Given her history of seizures and the fact that she has not been taking her seizure medication for two years, it is likely that her current symptoms are related to seizure activity. The recent event and feeling "off" could indicate a return of seizure activity or a change in her seizure pattern.
• Other Likely Diagnoses
  • Vasovagal Syncope: This condition is characterized by episodes of fainting, often triggered by stress or emotional events. The patient's history of passing out and feeling "off" after a recent event could suggest vasovagal syncope.
  • Migraine: Migraines can cause dizziness, fainting, and a feeling of being "off." The patient's use of ibuprofen without relief does not rule out migraine, as some migraines do not respond to over-the-counter pain relievers.
• Do Not Miss Diagnoses
  • Status Epilepticus: Although the patient reports that her episodes have decreased, the fact that she has not been taking her seizure medication and is now experiencing symptoms could indicate a risk for status epilepticus, a life-threatening condition.
  • Intracranial Hemorrhage or Stroke: These conditions can present with sudden onset of dizziness, fainting, and feeling "off." Given the patient's history of seizures, there could be an underlying vascular issue that needs to be ruled out.
  • Cardiac Arrhythmias: Certain arrhythmias can cause dizziness and fainting. It is crucial to consider cardiac causes, especially if the patient has a history of cardiac issues or if the episodes are triggered by exertion or specific positions.
• Rare Diagnoses
  • Mitochondrial Disorders: These disorders can cause a variety of neurological symptoms, including seizures, dizziness, and fainting. Given the patient's young age and history of seizures, a mitochondrial disorder could be considered if other diagnoses are ruled out.
  • Autoimmune Encephalitis: This is a rare condition characterized by an autoimmune response targeting the brain, leading to seizures, altered mental status, and other neurological symptoms. It would be considered if other diagnoses are ruled out and there are signs of an autoimmune process.