Differential Diagnosis
- Single most likely diagnosis
- Eclampsia or severe preeclampsia with HELLP syndrome: The patient's symptoms of severe headache, abdominal pain, nausea, vomiting, and elevated blood pressure are consistent with preeclampsia. The presence of a palpable abdominal mass and elevated serum β-hCG suggests pregnancy, which is further supported by the patient's last menstrual period being 4 months ago. The neurologic examination findings of hyperreflexia and sustained ankle clonus also support this diagnosis.
- Other Likely diagnoses
- Pregnancy-related complications (e.g., placental abruption, uterine rupture): These conditions can cause abdominal pain, nausea, vomiting, and elevated blood pressure, and should be considered in the differential diagnosis of a pregnant patient with these symptoms.
- Intracranial hypertension or pseudotumor cerebri: The patient's symptoms of severe headache, nausea, and vomiting, as well as the neurologic examination findings of hyperreflexia and sustained ankle clonus, could also be consistent with intracranial hypertension or pseudotumor cerebri.
- Do Not Miss
- Ectopic pregnancy: Although the patient has a palpable abdominal mass, which suggests an intrauterine pregnancy, ectopic pregnancy should always be considered in a sexually active female with abdominal pain and elevated β-hCG.
- Appendicitis: The patient's symptoms of abdominal pain, nausea, and vomiting could also be consistent with appendicitis, which can be a life-threatening condition if not promptly diagnosed and treated.
- Intracranial hemorrhage or stroke: The patient's severe headache and neurologic examination findings could also be consistent with an intracranial hemorrhage or stroke, which would require immediate medical attention.
- Rare diagnoses
- Arteriovenous malformation or other vascular anomalies: These conditions can cause severe headache, abdominal pain, and neurologic symptoms, but are relatively rare and would require further imaging studies to diagnose.
- Neurologic disorders (e.g., multiple sclerosis, spinal cord injury): These conditions can cause neurologic symptoms such as hyperreflexia and sustained ankle clonus, but are relatively rare and would require further evaluation to diagnose.