Differential Diagnosis for a Pregnant Patient with Acute Episode of Tachycardia, Dyspnea, Neurological Symptoms, and Paresthesias

• Single Most Likely Diagnosis

  • Preeclampsia with Severe Features: This condition is characterized by the onset of hypertension and often proteinuria after 20 weeks of gestation. Severe features can include symptoms like tachycardia, dyspnea, neurological symptoms (such as paresthesias), and severe pain, which can manifest as shooting pain in the lower back and hip joints due to the potential for HELLP syndrome (a complication of preeclampsia) or other associated conditions affecting multiple systems.

• Other Likely Diagnoses

  • Multiple Sclerosis (MS) Exacerbation: MS can present with neurological symptoms such as paresthesias in various parts of the body, including the head, hands, and feet. Pregnancy can sometimes trigger or exacerbate MS symptoms.
  • Pregnancy-Related Anxiety or Panic Disorder: These conditions can cause tachycardia, dyspnea, and may be accompanied by neurological symptoms due to hyperventilation or anxiety-induced paresthesias.
  • Musculoskeletal Issues: Conditions like sciatica or other musculoskeletal problems can cause shooting pain in the lower back and hip joints, and may be exacerbated by pregnancy.

• Do Not Miss Diagnoses

  • Pulmonary Embolism (PE): Although less likely, PE is a critical diagnosis that must not be missed due to its high mortality rate. Symptoms can include tachycardia, dyspnea, and potentially neurological symptoms if there is associated hypoxia.
  • Cardiac Conditions (e.g., Myocardial Infarction, Cardiomyopathy): These conditions can present with tachycardia and dyspnea and are critical to diagnose promptly due to their potential for severe outcomes.
  • Eclampsia: A severe complication of preeclampsia characterized by seizures, which could be preceded by neurological symptoms and must be considered in any pregnant patient with new-onset neurological symptoms.

• Rare Diagnoses

  • Neurological Disorders (e.g., Acute Demyelinating Neuropathy, Guillain-Barré Syndrome): These conditions are rare but can present with rapid onset of neurological symptoms including paresthesias and could be considered in the differential diagnosis if more common causes are ruled out.
  • Connective Tissue Diseases (e.g., Systemic Lupus Erythematosus): These can have a wide range of symptoms including musculoskeletal pain, neurological symptoms, and potentially tachycardia and dyspnea, especially if there is associated lupus nephritis or cardiopulmonary involvement.