Differential Diagnosis for Viral Meningitis
Given the symptoms of headache, mild nuchal rigidity, and pain in the eyes, the following differential diagnoses can be considered:
Single Most Likely Diagnosis
- Viral meningitis: This is the most likely diagnosis given the symptoms. Viral meningitis typically presents with headache, fever, and nuchal rigidity, and the presence of eye pain can be associated with certain viral etiologies, such as herpes simplex virus.
Other Likely Diagnoses
- Bacterial meningitis: Although less likely than viral meningitis given the mild nuchal rigidity, bacterial meningitis is a significant consideration due to its potential severity and need for prompt antibiotic treatment. Symptoms can overlap with viral meningitis, especially in early stages.
- Tension headache or migraine: These conditions can cause headache and eye pain but typically do not cause significant nuchal rigidity. However, they are common and should be considered in the differential.
- Sinusitis: Can cause headache and eye pain, especially if the sinuses around the eyes are involved. It might not typically cause nuchal rigidity but could be considered if other symptoms like facial pain or nasal congestion are present.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although unlikely given the mild symptoms, subarachnoid hemorrhage is a critical diagnosis that must not be missed due to its high morbidity and mortality. It typically presents with a sudden, severe headache but can occasionally have a more subtle onset.
- Encephalitis: Inflammation of the brain tissue, which can present with headache, fever, and altered mental status. The eye pain could be related to the involvement of certain areas of the brain.
- Temporal arteritis: Especially in older adults, this condition can cause headache and eye pain, and while it does not typically cause nuchal rigidity, it's a diagnosis that should not be missed due to the risk of vision loss.
Rare Diagnoses
- Lyme meningitis: Caused by Borrelia burgdorferi, this can present with headache, fever, and nuchal rigidity, similar to viral meningitis, but is less common and typically associated with other symptoms like a rash or history of tick exposure.
- Fungal meningitis: More common in immunocompromised patients, fungal meningitis can have a subacute presentation with headache, fever, and nuchal rigidity, but it is relatively rare compared to viral or bacterial causes.
- Sarcoidosis: A systemic disease that can affect the central nervous system and cause meningitis, presenting with headache, and potentially eye pain if there is involvement of the optic nerve or uveitis. It is a rare consideration but should be thought of in patients with known sarcoidosis or other systemic symptoms.