Differential Diagnosis for New Onset Immobility in a 74-Year-Old Female
Single Most Likely Diagnosis
- Deconditioning: Given the recent hospitalization for pericarditis with effusion, a period of prolonged bed rest could lead to significant deconditioning, resulting in new onset immobility. This is a common and often overlooked cause of functional decline in elderly patients.
Other Likely Diagnoses
- Musculoskeletal issues (e.g., osteoarthritis, muscle weakness): Age-related musculoskeletal changes could contribute to immobility, especially if there was a period of reduced mobility during the recent hospitalization.
- Neurological conditions (e.g., Parkinson's disease, stroke): Although the FAST-VAN (Field Assessment Stroke Triage for Emergency Destination) is negative, subtle neurological deficits or early stages of neurological diseases could still be contributing to immobility.
- Medication side effects: Given her history of depression, hypertension, and hypothyroidism, medications used to treat these conditions could potentially contribute to weakness or dizziness, leading to immobility.
Do Not Miss Diagnoses
- Spinal cord compression or cauda equina syndrome: Although less likely, these conditions are medical emergencies that could present with sudden onset of immobility and would require immediate intervention.
- Infectious processes (e.g., sepsis, meningitis): Despite unremarkable vital signs, elderly patients can present atypically, and an infectious process could lead to both immobility and variable mental status changes.
- Cardiovascular events (e.g., myocardial infarction, cardiac tamponade): Given her recent history of pericarditis with effusion, there is a heightened concern for cardiac complications that could lead to immobility.
Rare Diagnoses
- Guillain-Barré Syndrome: An autoimmune disorder that could result in rapid onset of muscle weakness leading to immobility, though it is relatively rare.
- Vitamin B12 deficiency: Could lead to neurological symptoms including weakness and difficulty walking, but would be less likely given the acute presentation.
- Endocrine disorders (e.g., adrenal insufficiency): Although her hypothyroidism is known, other endocrine abnormalities could potentially contribute to her symptoms, including immobility.