Differential Diagnosis for 13-year-old Male with Possible Seizure
- Single most likely diagnosis:
- Postictal confusion and psychosis: This is the most likely diagnosis given the patient's history of seizures, the witnessed episode of shaking and convulsions, and the acute confusion and disorganized thinking (e.g., "the ships in his head are burning") after the episode. Postictal psychosis is a known complication of seizures, especially in patients with a history of seizure disorders.
- Other Likely diagnoses:
- Complex partial seizure: The patient's confusion and disorganized thinking after the seizure, as well as the history of previous seizures, suggest the possibility of a complex partial seizure. This type of seizure can cause altered mental status, confusion, and sometimes psychotic symptoms.
- Status epilepticus: Although the patient had a single witnessed episode of shaking and convulsions, the possibility of status epilepticus (prolonged or recurrent seizures without full recovery between them) should be considered, especially if the patient has a history of seizure disorders.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Meningitis or encephalitis: These infections can cause seizures, confusion, and altered mental status. Although the labs show no abnormalities, it is crucial to consider these diagnoses due to their potential severity and the need for prompt treatment.
- Intracranial hemorrhage or stroke: These conditions can cause seizures, confusion, and altered mental status. Although less likely in a 13-year-old, they are potentially life-threatening and require immediate attention.
- Hypoglycemia: Low blood sugar can cause seizures, confusion, and altered mental status. It is essential to check the patient's blood glucose level, especially if there are no other obvious causes for the symptoms.
- Rare diagnoses:
- Autoimmune encephalitis: This is a rare condition characterized by inflammation of the brain, which can cause seizures, confusion, and altered mental status. It is essential to consider this diagnosis if other more common causes are ruled out.
- Mitochondrial disorders: These are a group of rare genetic disorders that can cause seizures, confusion, and altered mental status. They may be considered if the patient has a history of developmental delays or other systemic symptoms.