Differential Diagnosis

The patient's symptoms and history suggest a complex neurological condition. The following differential diagnosis is organized into categories:

• Single most likely diagnosis
  • Post-hemorrhagic epilepsy or seizure disorder: The patient has a history of a left cavernoma bleed, which can cause seizures or epilepsy. The symptoms of intermittent numbness, facial numbness, and throat pressure could be indicative of simple partial seizures or auras. The improvement and clear onset of symptoms also support this diagnosis.
• Other Likely diagnoses
  • Migraine or migraine variant: The patient's symptoms, such as neck pain, facial numbness, and visual disturbances ("eyes not wanting to read"), could be consistent with a migraine or migraine variant. The timing of symptoms around menstruation also supports this diagnosis, as hormonal changes can trigger migraines.
  • Anxiety disorder: The patient's symptoms of panic and throat pressure could be indicative of an anxiety disorder, which may be exacerbated by the underlying neurological condition.
  • Residual or recurrent effects of the cavernoma bleed: The patient may be experiencing residual effects from the bleed, such as damage to surrounding brain tissue or scarring, which could cause intermittent symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Rebleeding or new hemorrhage: Although the patient has had a contained bleed, there is still a risk of rebleeding or new hemorrhage, which would be a medical emergency.
  • Meningioma growth or recurrence: The patient has a history of a meningioma in the left sylvian fissure, and it is essential to monitor for growth or recurrence, which could cause new or worsening symptoms.
  • Venous thrombosis or cerebral vasculitis: These conditions can cause similar symptoms and would require prompt diagnosis and treatment to prevent serious complications.
• Rare diagnoses
  • Neurodegenerative disease (e.g., multiple sclerosis, amyotrophic lateral sclerosis): Although less likely, these conditions can cause a wide range of neurological symptoms and should be considered in the differential diagnosis.
  • Arteriovenous malformation (AVM) or other vascular anomaly: The patient's history of a cavernoma bleed increases the risk of other vascular anomalies, which could cause similar symptoms.