Differential Diagnosis
- Single most likely diagnosis
- Huntington disease: The patient's symptoms, including motor changes (inability to track objects, clumsiness, fidgeting), behavioral changes (acting out, combative behavior, depression), and a significant family history of similar symptoms (involuntary movements, gait ataxia, mood problems) in the father, strongly suggest Huntington disease. The disease typically manifests in the 30s-50s but can start as early as the teens.
- Other Likely diagnoses
- Tourette syndrome: Characterized by involuntary movements (tics) and sometimes accompanied by behavioral issues, Tourette syndrome could explain some of the patient's symptoms. However, the combination of significant motor symptoms, behavioral changes, and a specific family history makes it less likely than Huntington disease.
- Dystonia: Involves involuntary muscle contractions, which could explain the blinking or head-turning to track objects. However, dystonia alone does not fully account for the behavioral changes or the family history.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sydenham chorea: A condition associated with rheumatic fever, characterized by involuntary movements. Although the patient denies recent infections, it's crucial to consider this diagnosis due to its potential severity and the need for prompt treatment of the underlying cause.
- Tardive dyskinesia: Typically associated with long-term use of neuroleptic medications, which the patient denies. However, it's essential to thoroughly investigate any potential medication use, given the severity of the condition.
- Rare diagnoses
- Other neurodegenerative diseases: Such as spinocerebellar ataxias or dentatorubral-pallidoluysian atrophy, which could present with similar symptoms but are less common and would require specific diagnostic testing to confirm.
- Wilson's disease: A genetic disorder leading to copper accumulation in the body, which can cause neurological symptoms, including involuntary movements and psychiatric issues. Although rare, it's a critical diagnosis to consider due to its treatability if identified early.