Differential Diagnosis for Eyes Rolling Back and Mild Hand Tremor, Not Responding

• Single most likely diagnosis:
  • Seizure (post-ictal phase): The presentation of eyes rolling back and a mild hand tremor, combined with unresponsiveness, is highly suggestive of a seizure, particularly if the patient is in the post-ictal phase, where they may exhibit confusion, lethargy, and sometimes focal neurological signs like tremors.
• Other Likely diagnoses:
  • Syncope: Although less likely given the specific combination of symptoms, syncope (fainting) can sometimes present with brief seizure-like activity or tremors due to cerebral hypoperfusion. However, the eyes rolling back is more characteristic of a seizure.
  • Psychogenic Non-Epileptic Seizures (PNES): These can mimic epileptic seizures but are psychological in origin. The presence of a hand tremor and unresponsiveness could fit this diagnosis, but the eyes rolling back is more typical of an epileptic seizure.
• Do Not Miss diagnoses:
  • Hypoglycemia: Low blood sugar can cause confusion, loss of consciousness, and sometimes seizure-like activity or tremors. It's crucial to check blood glucose levels in any patient presenting with altered mental status.
  • Stroke: Although less likely with the described symptoms, a stroke can occasionally present with seizure or altered mental status. The hand tremor could be a focal neurological sign.
  • Meningitis/Encephalitis: Infections of the brain or meninges can cause seizures, altered mental status, and sometimes focal neurological signs. These conditions are medical emergencies.
• Rare diagnoses:
  • Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can cause myoclonus (sudden, involuntary jerks), tremors, and altered mental status, including seizures.
  • Hashimoto's Encephalopathy: A rare condition associated with Hashimoto's thyroiditis, characterized by altered mental status, seizures, and sometimes tremors. It's an important diagnosis to consider because it's treatable with corticosteroids.
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the brain and liver. Neurological symptoms can include tremors, seizures, and psychiatric symptoms, but it's much less common and typically presents in a younger population.