Differential Diagnosis for L.M.
- Single most likely diagnosis
- Migraine with aura: Given L.M.'s history of migraines with aura and the description of her episodes, which involve transient neurological symptoms such as paresthesia affecting different parts of her body, this diagnosis is highly plausible. The fact that she describes these episodes as different from her usual migraine presentation but has a known history of migraines with aura, and has recently discontinued her triptan medication, supports this consideration.
- Other Likely diagnoses
- Transient ischemic attack (TIA): Although L.M. is young and does not have a typical risk factor profile for TIAs, the transient nature of her symptoms could suggest a vascular cause. The lack of headache before the onset and the specific pattern of symptoms might distinguish it from her typical migraines, warranting consideration of a TIA.
- Multiple sclerosis (MS): MS can present with a wide range of neurological symptoms, including paresthesia, and can be difficult to diagnose. L.M.'s episodes of transient neurological symptoms could potentially be a clinically isolated syndrome, which is a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation or demyelination in the central nervous system.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke: Although less likely given L.M.'s age and lack of traditional risk factors, stroke must always be considered in the differential diagnosis for anyone presenting with acute neurological symptoms. The fact that her symptoms resolve spontaneously does not rule out stroke, as some strokes can have transient symptoms.
- Venous thrombosis or cerebral venous sinus thrombosis: Given L.M.'s history of irregular menstrual cycles and potential for hypercoagulability, especially if she is indeed pregnant or has other underlying conditions, venous thrombosis must be considered.
- Rare diagnoses
- Neuromyelitis optica spectrum disorder (NMOSD): This is an autoimmune disorder that predominantly affects the optic nerve and spinal cord but can present with a variety of neurological symptoms. It's less likely but should be considered, especially if MS is being entertained and further testing is warranted.
- Mitochondrial myopathies or other metabolic disorders: These conditions can present with a wide range of neurological symptoms, including transient episodes of paresthesia, but are less common and would typically be associated with other systemic symptoms or a family history.