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 associated with frontal head pressure, makes migraines a likely explanation for his symptoms. The recent episode of migraine and the patient's history of experiencing migraines since LASIK surgery support this diagnosis.
• Other Likely Diagnoses
  • Post-LASIK complications: Although the patient had a negative CT scan two years ago, complications from LASIK surgery, such as dry eye or residual refractive errors, could contribute to his symptoms of blurred vision and sensitivity to light.
  • Musculoskeletal strain: The patient's recent participation in HIT workouts could have caused musculoskeletal strain, leading to rib pain. This is a plausible explanation given the temporal relationship between the workouts and the onset of rib pain.
  • Anxiety or depression exacerbation: The patient's history of depression and anxiety, and the fact that he is taking medication for these conditions, suggests that an exacerbation of these conditions could be contributing to his symptoms, particularly the dizziness and blurred vision.
• Do Not Miss Diagnoses
  • Temporal arteritis: Although less likely given the patient's age and lack of other symptoms such as jaw claudication or scalp tenderness, temporal arteritis is a "do not miss" diagnosis due to its potential for causing blindness and the need for prompt treatment.
  • Subarachnoid hemorrhage or other intracranial hemorrhage: Despite the patient's negative CT scan two years ago, a new onset of severe headache, especially with features such as sudden onset, "thunderclap" nature, or associated with neurological deficits, would necessitate immediate imaging to rule out an intracranial hemorrhage.
  • Multiple sclerosis: This condition can present with a wide range of neurological symptoms, including vision problems, dizziness, and pain. Although less likely, it is a diagnosis that should not be missed due to its significant implications for the patient's long-term health.
• Rare Diagnoses
  • Ocular migraine: A condition characterized by recurrent episodes of visual disturbances, including blurred vision and sensitivity to light, which could be considered if other explanations for the patient's symptoms are ruled out.
  • Chiari malformation: A structural defect in the cerebellum that can cause a variety of symptoms, including headaches, dizziness, and visual disturbances. This diagnosis would be considered rare and would require specific imaging findings for confirmation.