Differential Diagnosis for 29-year-old Female with Seizure Disorder: New Hearing Loss and Severe Headache After Prolonged Somnolence
- Single most likely diagnosis
- Postictal state with complications: This is the most likely diagnosis given the patient's history of seizure disorder and the presentation of prolonged somnolence, which is a common postictal phenomenon. The new hearing loss and severe headache could be related to the seizure itself or a complication such as a postictal migraine or a condition like Todd's paralysis affecting the auditory system.
- Other Likely diagnoses
- Status epilepticus with residual effects: Although the patient is no longer actively seizing, the prolonged somnolence and new symptoms could indicate residual effects from status epilepticus, which requires immediate medical attention.
- Meningitis or encephalitis: Infections like meningitis or encephalitis can cause seizures, severe headache, and altered mental status, including prolonged somnolence. The new hearing loss could be due to involvement of the cranial nerves.
- Subarachnoid hemorrhage: A severe headache and prolonged somnolence could be indicative of a subarachnoid hemorrhage, especially if the seizure was a presenting symptom of the hemorrhage.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Brain tumor: Although less likely, a brain tumor could cause seizures, hearing loss, and severe headaches. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
- Cerebral venous sinus thrombosis: This condition can cause seizures, headache, and altered mental status. Given its potential for severe outcomes, it should not be missed.
- Reversible cerebral vasoconstriction syndrome (RCVS): RCVS can present with thunderclap headache and seizures, and it's essential to diagnose it promptly to initiate appropriate treatment.
- Rare diagnoses
- Susac syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and inner ear, leading to symptoms like hearing loss, vision changes, and headaches. Seizures can also occur.
- Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS): A rare mitochondrial disorder that can cause seizures, hearing loss, and severe headaches, among other symptoms.
- Neurosyphilis: Although rare, neurosyphilis can cause a wide range of neurological symptoms, including seizures, hearing loss, and severe headaches, especially in the tertiary stage of the disease.