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Differential Diagnosis for Seizure in 90F with Normal Non-Contrast CT Brain and pH of 7

  • Single Most Likely Diagnosis
    • Metabolic disturbances (e.g., hyponatremia, hypoglycemia, hyperglycemia): Given the patient's age and the normal CT scan, metabolic issues are a common cause of seizures in the elderly. Even with a normal pH, electrolyte imbalances can occur without significant acid-base disturbances.
  • Other Likely Diagnoses
    • Infection (e.g., meningitis, encephalitis): Although the CT scan is normal, infections can cause seizures, especially in the elderly. The absence of fever or other symptoms does not rule out infection.
    • Medication side effects or withdrawal: Many medications can lower the seizure threshold, and withdrawal from certain substances (e.g., benzodiazepines, alcohol) can also cause seizures.
    • Cerebrovascular disease: Even with a normal non-contrast CT, small vessel disease or recent strokes not visible on CT could be a cause.
  • Do Not Miss Diagnoses
    • Subarachnoid hemorrhage: Although the CT scan is reported as normal, a non-contrast CT can sometimes miss a subarachnoid hemorrhage, especially if it's small or the scan is done too early. This condition is life-threatening and requires immediate intervention.
    • Status epilepticus: If the seizure is ongoing or the patient has had repeated seizures without full recovery in between, this is a medical emergency.
    • Hypoxic-ischemic encephalopathy: If there was a recent episode of hypoxia or ischemia, this could lead to seizures, even if the CT appears normal initially.
  • Rare Diagnoses
    • Autoimmune encephalitis: This is a rare condition that can cause seizures, among other neurological symptoms, and might not be immediately apparent on initial imaging.
    • Paraneoplastic syndromes: Certain cancers can cause seizures through paraneoplastic syndromes, which are rare but important to consider, especially in the elderly.
    • Mitochondrial disorders: Although more common in younger populations, some mitochondrial disorders can present later in life and cause seizures.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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