Differential Diagnosis for 32-year-old Male Experiencing Eyes Rolling Up in Head

Single Most Likely Diagnosis

• Acute Dystonic Reaction: This condition is a common side effect of antipsychotic medications like Haldol, especially when used in conjunction with substances that can lower the seizure threshold or affect neurotransmitter balance, such as hallucinogens and alcohol. The symptom of eyes rolling up in the head is consistent with an oculogyric crisis, a type of acute dystonic reaction.

Other Likely Diagnoses

• Serotonin Syndrome: This is a potentially life-threatening medical condition resulting from an excess of serotonin in the central nervous system. It can be caused by the combination of certain medications and substances, including hallucinogens and alcohol. Symptoms can include altered mental status, neuromuscular abnormalities, and autonomic instability, which might indirectly cause or contribute to the eye-rolling symptom.
• Alcohol and Hallucinogen Withdrawal or Intoxication: The combination of alcohol and hallucinogens can lead to a variety of neurological and psychiatric symptoms, including altered states of consciousness, hallucinations, and potentially abnormal movements or postures, though eyes rolling up is less commonly described.

Do Not Miss Diagnoses

• Status Epilepticus: Although less likely, status epilepticus (a medical emergency characterized by prolonged or recurrent seizures without full recovery between them) can present with a variety of seizure types, including those with minimal motor symptoms. The use of Haldol and the consumption of hallucinogens and alcohol could potentially lower the seizure threshold.
• Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening side effect of neuroleptic medications like Haldol, characterized by fever, muscle stiffness, autonomic dysfunction, and altered mental status. Early recognition is crucial.

Rare Diagnoses

• Tardive Dyskinesia: Although typically associated with long-term use of antipsychotic medications, in rare cases, it could be considered if the patient has a history of such medication use. However, the acute onset after a single dose of Haldol makes this less likely.
• Psychogenic Nonepileptic Seizures (PNES): These are events that resemble epileptic seizures but are not caused by abnormal electrical activity in the brain. They are psychological in origin and could potentially be triggered by the stress of substance use or the reaction to Haldol. However, the specific symptom of eyes rolling up would be an unusual presentation for PNES.