Differential Diagnosis for Vision Changes in a 17-Year-Old Vegan Girl
Single Most Likely Diagnosis
- Vitamin A Deficiency: Given the patient's strict vegan diet and symptoms of night blindness, this diagnosis is highly plausible. Vitamin A is crucial for the health of the retina, and its deficiency can lead to night blindness and other visual disturbances. The patient's diet, lacking in animal products which are primary sources of vitamin A, increases the risk of this deficiency.
Other Likely Diagnoses
- Retinitis Pigmentosa: This is a group of genetic disorders that affect the retina's ability to respond to light, often leading to night blindness and progressive vision loss. The patient's visual field defects and funduscopic findings could be consistent with this condition.
- Diabetic Retinopathy: Although less likely given the patient's age and lack of mentioned diabetes symptoms, diabetic retinopathy can cause a variety of visual disturbances, including night blindness, due to damage to the blood vessels in the retina.
Do Not Miss Diagnoses
- Brain Tumor: A tumor pressing on the optic nerve or other parts of the brain involved in vision could cause visual field defects and other symptoms described. Although less likely, missing this diagnosis could have severe consequences.
- Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including vision problems. Optic neuritis, often associated with multiple sclerosis, could explain some of the patient's symptoms.
Rare Diagnoses
- Leber's Congenital Amaurosis: A rare inherited eye disease that appears in infancy and can cause severe visual impairment, including night blindness. It's less likely given the patient's age at onset but could be considered in the differential.
- Choroideremia: A rare genetic disorder that causes progressive loss of the choroid, retina, and retinal pigment epithelium, leading to night blindness and progressive vision loss. It primarily affects males but should be considered in any patient with unexplained visual disturbances.