Differential Diagnosis for Patient's Symptoms
The patient presents with "tingling" hands and feet, diaphoresis, tunnel vision, "pixilated vision," and whole body numbness. Considering these symptoms, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Panic Attack or Anxiety Disorder: The patient's symptoms, such as tingling hands and feet, diaphoresis, tunnel vision, and whole body numbness, are consistent with a panic attack. The onset of these symptoms over a short period (approximately 2 days ago) and the patient's past experiences being turned away from medical facilities, which may have led to avoidance of seeking immediate help, support this diagnosis.
Other Likely Diagnoses
- Hyperventilation Syndrome: This condition can cause tingling in the hands and feet, dizziness, and visual disturbances due to rapid breathing, which could be triggered by anxiety or stress.
- Vitamin B12 Deficiency: This deficiency can cause numbness or tingling in the hands and feet, but the acute onset of other symptoms like tunnel vision and whole body numbness makes it less likely.
- Hypoglycemia: Although less likely given the description, hypoglycemia can cause diaphoresis, tingling, and visual disturbances, especially if the patient has a history of diabetes or is on certain medications.
Do Not Miss Diagnoses
- Multiple Sclerosis (MS): Although less common, MS can present with a wide range of neurological symptoms, including numbness, tingling, and vision problems. Missing this diagnosis could lead to delayed treatment and significant morbidity.
- Transient Ischemic Attack (TIA) or Stroke: While the patient's symptoms do not classically present as a TIA or stroke, it's crucial not to miss these diagnoses due to their high morbidity and mortality. The sudden onset of neurological symptoms warrants consideration of vascular causes.
- Seizure Disorder: Certain types of seizures, especially complex partial seizures, can present with a variety of symptoms including altered perception (like "pixilated vision") and numbness.
Rare Diagnoses
- Peripheral Neuropathy: This is a broad category of disorders that can cause numbness and tingling but typically has a more gradual onset.
- Mitochondrial Myopathies: These are a group of disorders that affect the mitochondria and can cause a wide range of symptoms including neurological and muscular issues, but they are rare and usually have a more chronic presentation.
- Heavy Metal Poisoning: Exposure to certain heavy metals can cause neurological symptoms, but this would be an unusual presentation without a clear exposure history.