Differential Diagnosis for 39 yo F with Long COVID Symptoms and Left Sided Head Pressure
- Single Most Likely Diagnosis
- Sinusitis: The presence of mild polypoid mucosal thickening in the left maxillary sinus on imaging, combined with the symptom of left-sided head pressure, strongly suggests sinusitis as the most likely diagnosis. The symptoms of headaches and facial pressure are common in sinusitis, and the involvement of the maxillary sinus can cause pain or pressure in the cheek area, which might be perceived as head pressure.
- Other Likely Diagnoses
- Migraine: Given the history of lingering headaches, migraine could be a contributing factor to her current symptoms. Migraines can be unilateral and are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
- Tension Headache: This is another common type of headache that could be exacerbated by the stress of dealing with long COVID symptoms. Tension headaches are typically bilateral but can be unilateral and are often described as a band or a squeezing sensation around the forehead.
- Post-COVID Syndrome: Some patients experience persistent or new symptoms after COVID-19, including headaches. The mechanism is not fully understood but could be related to the immune response, inflammation, or direct viral effects.
- Do Not Miss Diagnoses
- Intracranial Hypertension (Idiopathic or Secondary): Although the brain MRI was normal, it's crucial to consider conditions that could lead to increased intracranial pressure, as they can present with headache and might not always show abnormalities on initial imaging. Symptoms can include headache, vision changes, and papilledema.
- Cerebral Venous Thrombosis: This is a rare condition but can be deadly if missed. It might present with headache, and while the MRI was normal, specific sequences (like MR venography) are needed to rule out venous thrombosis.
- Temporal Arteritis: This condition, although more common in older adults, can present with headache and should be considered, especially if there are other symptoms like jaw claudication or visual disturbances.
- Rare Diagnoses
- Sphenoid Sinusitis: While less common than maxillary sinusitis, sphenoid sinusitis can cause headache, typically in the vertex or occipital region, but can also refer pain to other areas of the head.
- Nasal Tumors or Cysts: These could cause unilateral head pressure or pain if they obstruct the sinuses or exert pressure on surrounding structures.
- Trigeminal Neuralgia: A condition characterized by intense pain along a branch of the trigeminal nerve, which could be mistaken for sinusitis or other causes of head pressure.