Differential Diagnosis for New Onset Seizure without Fever
Single Most Likely Diagnosis
- Idiopathic Epilepsy: This is often the most common cause of new onset seizures in individuals without a clear underlying cause. It is a diagnosis of exclusion, made after other potential causes have been ruled out.
Other Likely Diagnoses
- Traumatic Brain Injury: A history of recent head trauma can lead to seizures, even if the initial injury seemed minor.
- Stroke or Transient Ischemic Attack (TIA): Seizures can be a presenting symptom of a stroke or TIA, especially in older adults.
- Infections (Meningitis, Encephalitis): Although the question specifies "without fever," it's crucial to consider infections, as some cases may not present with typical symptoms like fever.
- Substance Withdrawal: Withdrawal from substances like alcohol or benzodiazepines can cause seizures.
- Metabolic Disorders: Electrolyte imbalances (e.g., hyponatremia, hypocalcemia) or other metabolic issues can precipitate seizures.
Do Not Miss Diagnoses
- Central Nervous System (CNS) Tumors: Although less common, CNS tumors can cause seizures and are critical to diagnose early.
- Cerebral Venous Thrombosis: This condition can present with seizures and is often associated with specific risk factors like pregnancy or oral contraceptive use.
- Intracranial Hemorrhage: Any form of bleeding within the brain can cause a seizure and requires immediate medical attention.
- Status Epilepticus: If the seizure is prolonged or recurs without full recovery in between, it's considered status epilepticus, a medical emergency.
Rare Diagnoses
- Autoimmune Encephalitis: A group of conditions that involve an autoimmune response targeting the brain, which can cause seizures among other symptoms.
- Mitochondrial Disorders: Rare genetic disorders affecting the mitochondria, which can lead to seizures as part of a broader spectrum of symptoms.
- Vasculitis: Inflammation of the blood vessels in the brain can cause seizures, though this is relatively rare.
- Parasitic Infections (e.g., Neurocysticercosis): In certain geographic areas or in individuals with specific exposure histories, parasitic infections can cause seizures.