Differential Diagnosis for Diplopia and Dizziness in a Chemo Patient for Lymphoma
Single Most Likely Diagnosis
- Chemotherapy-induced neurotoxicity: This is a common side effect of various chemotherapeutic agents used in the treatment of lymphoma, which can cause neurological symptoms including diplopia (double vision) and dizziness due to its effects on the nervous system.
Other Likely Diagnoses
- Vestibular dysfunction: Chemotherapy can affect the inner ear, leading to vestibular problems that cause dizziness and balance issues. Additionally, lymphoma itself can involve the central nervous system, potentially affecting areas responsible for balance and vision.
- Metabolic disturbances: Chemotherapy and lymphoma can lead to various metabolic imbalances (e.g., electrolyte disturbances, hypocalcemia) that may cause neurological symptoms including dizziness and visual disturbances.
- Medication side effects: Besides chemotherapy, other medications used in the management of lymphoma or its symptoms (e.g., steroids, anti-emetics) can have side effects that include dizziness and visual disturbances.
Do Not Miss Diagnoses
- Central nervous system (CNS) lymphoma: Although less common, lymphoma can directly involve the CNS, leading to a wide range of neurological symptoms including diplopia and dizziness. Missing this diagnosis could be catastrophic.
- Posterior reversible encephalopathy syndrome (PRES): This is a condition associated with certain chemotherapy agents and can cause visual disturbances, dizziness, and other neurological symptoms due to brain edema.
- Cerebral vasculitis: Inflammation of the blood vessels in the brain can be a complication of lymphoma or its treatment, leading to neurological symptoms.
Rare Diagnoses
- Paraneoplastic syndromes: These are rare disorders that are triggered by an altered immune system response to a neoplasm, such as lymphoma. They can cause a variety of neurological symptoms, including those affecting vision and balance.
- Wernicke's encephalopathy: A rare but serious condition caused by thiamine deficiency, which can be associated with chemotherapy and alcohol use, leading to symptoms that include dizziness and ophthalmoplegia (weakness or paralysis of one or more extraocular muscles).