Differential Diagnosis for Abrupt Onset Vision Changes, Upper Extremity Neuropathy, Extreme Fatigue, Altered Mental Status (AMS), and Transient and Recurrent Symptoms

Single Most Likely Diagnosis

• Multiple Sclerosis (MS): This condition is characterized by demyelination in the central nervous system, which can lead to a wide range of neurological symptoms, including vision changes, neuropathy, fatigue, and AMS. The transient and recurrent nature of the symptoms also fits with the relapsing-remitting pattern often seen in MS.

Other Likely Diagnoses

• Stroke or Transient Ischemic Attack (TIA): Abrupt onset of vision changes and upper extremity neuropathy could indicate a vascular event. While AMS and extreme fatigue are less common as isolated symptoms in stroke/TIA, they can occur, especially if the event affects areas critical for these functions.
• Optic Neuritis: This condition, often associated with MS, can cause sudden vision loss. However, when considered in isolation, it might not fully explain all symptoms, particularly the systemic ones like extreme fatigue and AMS.
• Neuropathy due to Vitamin Deficiency: Deficiencies in vitamins like B12 can cause neuropathy, fatigue, and, less commonly, visual disturbances. The symptoms can be gradual but may seem abrupt if the deficiency has been progressing unnoticed.

Do Not Miss Diagnoses

• Giant Cell Arteritis: This condition can cause sudden vision loss and is a medical emergency. While it primarily affects older adults and is associated with headache and jaw claudication, missing this diagnosis can lead to permanent vision loss.
• Cavernous Sinus Thrombosis: A rare but potentially life-threatening condition that can cause sudden vision changes, neuropathy, and AMS due to its strategic location affecting multiple cranial nerves and the brain.
• Meningitis or Encephalitis: Infections of the meninges or brain can present with AMS, vision changes, and neuropathy. These conditions are medical emergencies requiring prompt treatment.

Rare Diagnoses

• Mitochondrial Myopathies: These are a group of disorders affecting the mitochondria, leading to muscle weakness, neuropathy, and sometimes visual disturbances. They can present with extreme fatigue and may have a relapsing-remitting course.
• Susac Syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and inner ear, leading to a combination of neurological and visual symptoms.
• Neurosyphilis: A condition that can cause a wide range of neurological symptoms, including vision changes, neuropathy, and AMS, especially in its late stages. Its diagnosis is often considered in high-risk populations or when other diagnoses are ruled out.