Differential Diagnosis
- Single most likely diagnosis
- Tourette Syndrome: This condition is characterized by the presence of multiple motor and vocal tics, which can be exacerbated by anxiety. The patient's symptoms of involuntary movements, frequent throat clearing, and inappropriate laughing are consistent with this diagnosis. The urge for frequent hand cleaning may also be related to obsessive-compulsive behaviors often seen in Tourette Syndrome.
- Other Likely diagnoses
- Anxiety Disorder: The patient's symptoms worsen with anxiety, and the presence of obsessive behaviors (frequent hand cleaning) suggests an underlying anxiety disorder.
- Obsessive-Compulsive Disorder (OCD): The patient's urge for frequent hand cleaning and the presence of tics may be indicative of OCD, which can sometimes be associated with tic disorders.
- Sydenham Chorea: This condition is characterized by involuntary movements, particularly in children, and can be associated with streptococcal infections (suggested by enlarged and hyperemic tonsils). However, it typically presents with more pronounced choreiform movements and often has a more acute onset.
- Do Not Miss
- Neurodegenerative Disorders (e.g., Huntington's Disease): Although rare in children, these disorders can present with movement abnormalities and psychiatric symptoms. Missing such a diagnosis could have significant implications for the patient's prognosis and family planning.
- Infections (e.g., Lyme Disease, Encephalitis): Certain infections can cause a wide range of neurological symptoms, including movement disorders and psychiatric symptoms. It is crucial to consider these diagnoses to provide appropriate treatment.
- Autoimmune Disorders (e.g., PANDAS): Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) can present with sudden onset of OCD symptoms, tics, and other neurological abnormalities following a streptococcal infection.
- Rare diagnoses
- Wilson's Disease: A genetic disorder that can cause neurological symptoms, including movement disorders, due to copper accumulation in the brain. It is rare but should be considered in cases of unexplained movement disorders.
- Lesch-Nyhan Syndrome: A genetic disorder characterized by self-mutilation, intellectual disability, and movement disorders. It is extremely rare and typically presents in early childhood.