Differential Diagnoses
Differential Diagnosis 1:
Multiple Sclerosis
The patient presents with the chief complaint of frequent episodes of weakness, and a tingling sensation in different areas of her body. The majority of patients with MS will have muscle weakness in their extremities as well as paresthesias. Some patients will experience cognitive impairments including concentration, attention and memory issues as well as dizziness, tremors, and bowel and bladder symptoms. The onset of Multiple Sclerosis is typically between the ages of 20 and 40. Females are two times as likely to develop this disease over males and the highest prevalence is in whites. In about 15% of cases, those diagnosed have a family member also diagnosed MS. Pregnancy can precipitate an exacerbation and this most frequently occurs 3 months postpartum. Cigarette smoking and Epstein-Barr virus are among several environmental risk factors for this autoimmune disease. (National Institute of Neurological Disorders and Stroke, 2015)
Image retrieved from https://en.wikipedia.org/wiki/Multiple_sclerosis#/media/File:Symptoms_of_multiple_sclerosis.svg
Differential Diagnosis 2:
Spinal Cord Tumor
Symptoms of spinal cord tumors vary depending on the location of the tumor and are gradual and progressive. Sensory symptoms of tumors in the thoracic region can include tingling paresthesias that typically start in one leg. Bowel and bladder dysfunction can be present as well but typically appear with leg paresis. Metastatic tumors are 3-4 times more common than primary. The patient’s social history includes smoking so it is possible that she has either primary or metastatic. Cancer of the breast, lung and prostate are the most common that metastasize to the spinal cord. (McCane and Huether, 2014)
Image retrieved from http://radiopaedia.org/articles/spinal-ependymoma
Differential Diagnosis 3:
Lyme Disease
The patient’s social history includes that she is a hiker who returned recently from a several day hike. This places her at risk for contracting Lyme disease which is a tickborne disease. If left untreated, there can be a wide range of symptoms. Some of the later symptoms, days to months after the tick bite, include episodes of dizziness, numbness or tingling in the hands or feet and short term memory problems as well as facial paralysis, rash and arthritis. (Centers for Disease Control and Prevention, 2015)
Image retrieved from http://www.cdc.gov/lyme/signs_symptoms/index.html