Differential Diagnosis
- Single most likely diagnosis
- A. Idiopathic intracranial hypertension: This condition is characterized by increased intracranial pressure without a detectable cause, often presenting with symptoms such as headache and visual disturbances, including scotomas. The patient's history of obesity (BMI of 41) and use of the combined oral contraceptive pill, which are risk factors for idiopathic intracranial hypertension, along with the MRI findings of an empty sella and dilated asymmetric cerebrovenous sinuses, supports this diagnosis.
- Other Likely diagnoses
- B. Migraine: Although migraines can cause pulsatile headaches and visual disturbances, the absence of photophobia and the specific MRI findings make idiopathic intracranial hypertension more likely. However, migraine cannot be ruled out entirely without further evaluation.
- Do Not Miss
- D. Central venous sinus thrombosis: This is a potentially life-threatening condition that can present with headache and visual symptoms. The presence of dilated asymmetric cerebrovenous sinuses on MRI could be suggestive of this condition, and it is crucial to consider and rule out thrombosis due to its severe implications.
- C. Posterior reversible encephalopathy syndrome (PRES): While less likely given the specific symptoms and MRI findings, PRES is a condition that can cause severe complications and should be considered, especially in patients with risk factors such as hypertension or immunosuppression, though it's not explicitly mentioned in the patient's history.
- Rare diagnoses
- Other rare conditions that could potentially cause similar symptoms, such as cerebral venous malformations or less common causes of increased intracranial pressure, would be considered rare diagnoses. These would require additional specific findings or a lack of explanation by the more common diagnoses to be seriously entertained.