Differential Diagnosis

The patient presents with a complex set of symptoms including intermittent dizziness, blurred vision, sensitivity to light, migraines, and new-onset rib pain. Considering the patient's history and symptoms, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Migraines: The patient's history of migraines, especially triggered by sensitivity to light and located in the frontal area of the head, makes this a likely diagnosis. The symptoms of dizziness and blurred vision can also be associated with migraines. The patient's history of LASIK surgery and the onset of migraines with frontal head pressure post-surgery further supports this diagnosis.
• Other Likely Diagnoses
  • Anxiety or Depression Exacerbation: Given the patient's history of depression and anxiety, and the current symptoms of dizziness and blurred vision, it's possible that the patient is experiencing an exacerbation of their psychiatric conditions, which could be contributing to or mimicking physical symptoms.
  • Musculoskeletal Injury: The new-onset rib pain, especially after doing HIT (High-Intensity Training) workouts, could be indicative of a musculoskeletal injury such as a strain or bruise.
  • Post-LASIK Complications: Although the patient had a negative CT scan two years ago, it's still possible that there are complications from the LASIK surgery that could be contributing to the patient's symptoms, such as dry eye or other vision problems.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although the patient denies double vision or loss of balance and the last CT scan was negative, a subarachnoid hemorrhage is a potentially life-threatening condition that could cause sudden onset of headache, sensitivity to light, and other neurological symptoms. It's crucial to consider this diagnosis, especially given the patient's history of migraines, which could potentially mask the symptoms of a more serious condition.
  • Temporal Arteritis: This condition, also known as giant cell arteritis, can cause headaches, vision problems, and sensitivity to light. It's more common in older adults but should be considered, especially if the patient has other systemic symptoms.
  • Multiple Sclerosis: This chronic condition can cause a wide range of neurological symptoms, including vision problems, dizziness, and pain. Although less likely, it's a diagnosis that should not be missed due to its significant impact on the patient's quality of life.
• Rare Diagnoses
  • Occipital Neuralgia: A condition characterized by inflammation of the occipital nerves, leading to pain in the back and top of the head, which could potentially cause some of the patient's symptoms.
  • Craniocervical Junction Anomalies: Abnormalities in the junction between the skull and the cervical spine can cause a variety of symptoms, including headaches, dizziness, and vision problems. This would be a rare but possible cause of the patient's symptoms.