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 the MRI shows white matter injury, it is essential to consider the possibility of an intracranial hemorrhage or infarction, which could have occurred due to the patient's preterm birth and could be contributing to her symptoms.
- Do Not Miss Diagnoses
- Infectious or Inflammatory Conditions (e.g., Meningitis, Encephalitis): Although less likely, it is crucial to rule out infectious or inflammatory conditions that could cause increased intracranial pressure, leading to the patient's symptoms. These conditions can be life-threatening if not promptly diagnosed and treated.
- Tumors or Space-Occupying Lesions: Although rare, it is essential to consider the possibility of a tumor or space-occupying lesion, which could be causing the patient's symptoms by compressing or damaging surrounding brain tissue.
- Rare Diagnoses
- Genetic or Metabolic Disorders (e.g., Pyruvate Dehydrogenase Deficiency): Certain genetic or metabolic disorders can cause neurological symptoms and white matter injury. Although rare, these conditions should be considered if the patient's symptoms do not respond to treatment or if there are other suggestive findings.
- Vascular Malformations or Moyamoya Disease: These rare conditions can cause stroke or cerebral ischemia, leading to symptoms similar to those presented by the patient. Although unlikely, they should be considered if other diagnoses are ruled out.