Differential Diagnosis for a 7-Month-Old Girl with Decreased Use of Her Left Arm
- Single Most Likely Diagnosis
- Cerebral Palsy (CP): Given the patient's preterm birth, white matter injury adjacent to the right lateral ventricle on MRI, increased tone in the left upper and lower extremities, and presence of clonus and Babinski reflex, cerebral palsy is the most likely diagnosis. The patient's symptoms and examination findings are consistent with spastic hemiplegia, a common subtype of CP.
- Other Likely Diagnoses
- Periventricular Leukomalacia (PVL): The patient's MRI showing white matter injury adjacent to the right lateral ventricle is consistent with PVL, a condition commonly seen in preterm infants. PVL can lead to cerebral palsy, which aligns with the patient's clinical presentation.
- Intracranial Hemorrhage or Infarction: Although less likely given the provided MRI findings, it's possible that the patient had an intracranial hemorrhage or infarction, which could have caused the white matter injury and subsequent neurological deficits.
- Do Not Miss Diagnoses
- Infectious or Inflammatory Conditions (e.g., Meningitis, Encephalitis): Although the patient's presentation does not strongly suggest an infectious or inflammatory condition, it's essential to consider these diagnoses due to their potential for severe consequences if missed. These conditions can cause neurological deficits, seizures, and other symptoms that may overlap with the patient's presentation.
- Tumors or Space-Occupying Lesions: Although rare in infants, tumors or space-occupying lesions can cause focal neurological deficits, increased intracranial pressure, and other symptoms that may mimic the patient's presentation.
- Rare Diagnoses
- Genetic or Metabolic Disorders (e.g., Pyruvate Dehydrogenase Deficiency, Glutaric Aciduria Type 1): Certain genetic or metabolic disorders can cause neurological deficits, developmental delays, and other symptoms that may be similar to the patient's presentation. While these conditions are rare, they should be considered in the differential diagnosis, especially if the patient's symptoms do not fully align with more common conditions like cerebral palsy.
- Stroke or Arteriovenous Malformation: Although rare in infants, stroke or arteriovenous malformation can cause focal neurological deficits, seizures, and other symptoms that may overlap with the patient's presentation.