Differential Diagnosis for a 40-year-old Reporting Seeing Spots for 5 Days

Single Most Likely Diagnosis

• Migraine with Aura: This condition is characterized by visual disturbances, such as seeing spots, which can be triggered by stress, including the loss of a loved one. The continuation of symptoms despite the initial attribution to grief suggests a physiological basis.

Other Likely Diagnoses

• Vitamin Deficiencies (e.g., Vitamin B12): Deficiencies in certain vitamins can lead to visual disturbances, including seeing spots or floaters. This could be a consideration if the patient has a diet lacking in essential nutrients or has conditions leading to malabsorption.
• Dry Eye Syndrome: Prolonged periods of stress, as experienced after a loss, can exacerbate dry eye, leading to visual disturbances such as seeing spots.
• Hypertension: Uncontrolled high blood pressure can cause changes in vision, including seeing spots, due to its effects on the blood vessels in the retina.

Do Not Miss Diagnoses

• Retinal Detachment: Although less common, retinal detachment is a medical emergency that can cause sudden visual disturbances, including seeing spots or floaters. It requires immediate attention to prevent permanent vision loss.
• Diabetic Retinopathy: In patients with diabetes, high blood sugar levels can damage the blood vessels in the retina, leading to visual disturbances. This condition can be asymptomatic until advanced stages, making regular screening crucial.
• Brain Tumors or Stroke: While rare, brain tumors or stroke can cause visual disturbances, including seeing spots. These conditions are medical emergencies and can have severe consequences if not promptly diagnosed and treated.

Rare Diagnoses

• Ocular Migraine: Similar to migraine with aura but specifically affecting the eyes, causing temporary visual disturbances.
• Syphilis: In its late stages, syphilis can cause a variety of ocular symptoms, including visual disturbances.
• Lymphoma: Certain types of lymphoma can affect the eyes and cause visual symptoms, although this is exceedingly rare.

Each of these diagnoses should be considered in the context of the patient's full medical history, lifestyle, and additional symptoms. A comprehensive examination, including ophthalmologic evaluation and possibly neurologic assessment, would be necessary to determine the underlying cause of the patient's symptoms.