Differential Diagnosis for Swallowing Difficulty
Given the patient's history and presentation, the following differential diagnoses are considered:
- Single most likely diagnosis
- Conversion Disorder (Functional Neurological Disorder): The patient's symptoms began after a stressful event (receiving the shingles vaccine and fearing GBS), and despite normal swallowing studies, they continue to experience difficulty swallowing. This pattern is consistent with a conversion disorder, where psychological distress is converted into physical symptoms.
- Other Likely diagnoses
- Anxiety Disorder: The patient's anxiety about having GBS after receiving the vaccine may have contributed to their swallowing difficulties, and ongoing anxiety could be perpetuating their symptoms.
- Somatoform Disorder: This diagnosis is considered due to the patient's focus on physical symptoms (swallowing difficulty) and their persistence despite normal diagnostic tests.
- Depression: Depression can manifest with somatic symptoms, including changes in appetite and eating habits, which could contribute to the patient's swallowing difficulties.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Amyotrophic Lateral Sclerosis (ALS): Although the patient's normal swallowing studies make this less likely, ALS can present with isolated bulbar symptoms, and missing this diagnosis could have devastating consequences.
- Multiple Sclerosis: This condition can cause swallowing difficulties, and although the patient's presentation is not typical, it is essential to consider MS to avoid missing a potentially treatable condition.
- Cancer (e.g., esophageal or brain cancer): Although rare, cancer can cause swallowing difficulties, and a thorough evaluation is necessary to rule out this possibility.
- Rare diagnoses
- Mitochondrial Myopathies: These rare genetic disorders can cause muscle weakness, including the muscles involved in swallowing.
- Myasthenia Gravis: This autoimmune disorder can cause muscle weakness, including the muscles involved in swallowing, although it is relatively rare.
- Rasmussen's Encephalitis: This rare inflammatory brain disease can cause a range of symptoms, including swallowing difficulties, although it is extremely rare and usually presents with other prominent symptoms.