Differential Diagnosis for a 13-year-old Girl with Progressive Headaches
- Single most likely diagnosis:
- Idiopathic Intracranial Hypertension (IIH): The patient's symptoms of progressive headaches, optic disc edema, and normal neurological examination are consistent with IIH. The recent change in growth pattern, with a decrease in height percentile, could be related to hormonal changes or increased intracranial pressure affecting the hypothalamic-pituitary axis.
- Other Likely diagnoses:
- Brain Tumor: The worsening headaches, especially those that awaken the patient from sleep, and the optic disc edema raise concern for a space-occupying lesion. The change in growth pattern could be related to the tumor's effect on the hypothalamic-pituitary axis.
- Hydrocephalus: This condition can cause increased intracranial pressure, leading to headaches and optic disc edema. The patient's stable weight and recent decrease in height percentile might be related to increased pressure affecting growth hormone regulation.
- Hypothyroidism: Although less likely, hypothyroidism can cause headaches and growth delays. The patient's stable weight and recent decrease in height percentile, along with a delayed sexual maturity rating, might suggest a hormonal imbalance.
- Do Not Miss diagnoses:
- Meningitis or Encephalitis: Although the patient's neck is supple, and the examination does not strongly suggest an infectious process, these conditions can present with headache and require urgent diagnosis and treatment.
- Cranial Sinus Thrombosis: This condition can cause increased intracranial pressure and headaches, especially if there are underlying prothrombotic conditions or dehydration.
- Pseudotumor Cerebri Syndrome secondary to Medication or Vitamin A toxicity: Certain medications or excessive vitamin A intake can cause increased intracranial pressure, leading to symptoms similar to IIH.
- Rare diagnoses:
- Sarcoidosis: This condition can cause increased intracranial pressure and growth delays, although it is less common in pediatric patients.
- Langerhans Cell Histiocytosis: This rare condition can affect the central nervous system, causing increased intracranial pressure, growth delays, and hormonal imbalances.
- Cushing's Disease: Although rare, Cushing's disease can cause growth delays, headaches, and optic disc edema due to increased intracranial pressure from a pituitary tumor.