Differential Diagnosis for 18-year-old with Visual Aura, Syncope, and Vomiting
- Single most likely diagnosis:
- Migraine with aura: This condition is characterized by a visual aura (such as zigzag patterns or flashing lights) followed by headache, nausea, and sometimes vomiting. The visual disturbances can be intense enough to cause transient loss of consciousness or a feeling of passing out.
- Other Likely diagnoses:
- Epilepsy (specifically, a seizure disorder): The visual aura could be a manifestation of a seizure, and the loss of consciousness and vomiting could follow as post-ictal symptoms.
- Vasovagal syncope: This is a common cause of fainting spells in young adults, often triggered by stress, pain, or prolonged standing. While it doesn't typically cause visual auras, the stress of experiencing an aura could potentially trigger a vasovagal response.
- Anxiety or panic attack: Severe anxiety can cause a range of symptoms including visual disturbances, lightheadedness, and nausea, potentially leading to vomiting.
- Do Not Miss diagnoses:
- Subarachnoid hemorrhage: Although less common in young adults, a sudden, severe headache (often described as "the worst headache of my life") accompanied by visual disturbances, loss of consciousness, and vomiting could indicate a life-threatening bleed in the brain.
- Intracranial tumor or cyst: Space-occupying lesions in the brain can cause increased intracranial pressure, leading to symptoms such as visual disturbances, nausea, vomiting, and loss of consciousness.
- Cardiac arrhythmias (e.g., long QT syndrome): Certain heart conditions can cause syncope and, in rare cases, might be associated with visual auras if there's a transient decrease in cerebral blood flow.
- Rare diagnoses:
- Porphyria: A group of rare genetic disorders that can cause a range of neurological symptoms, including visual disturbances, abdominal pain, and vomiting.
- Mitochondrial disorders: Conditions like MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) can present with a variety of symptoms including seizures, visual disturbances, and episodes of vomiting.