Differential Diagnosis I – Multiple Sclerosis
Figure 1. Myelin damage and the nervous system (Mayo Clinic, 2017)
Rationale:
The patient’s complaints of progressive numbness over that past year with the occurrence of a fall while running combined with her age and gender indicates the possibility of this diagnosis. The patient reported her symptoms come and go, which is a common occurance when Multiple Sclerosis (MS) first presents (McCance & Huether, 2014). Motor ataxia, diplopia, and bladder dysfunction are all common symptoms during an acute relapse episode with MS (McCance & Huether, 2014).
Differential Diagnosis II – Guillain-Barre Syndrome
Figure 2. Guillain- Barre Syndrome Nerve Cell (Mayo Clinic, 2017)
Rationale:
The patient displays a paresis that starts in the lower extremities and progresses up to her hands and waist. When looking at Guillain-Barre, an ascending paresis/paralysis involving the limbs moving up toward the respiratory & bulbar muscles tends to be the initial presentation (McCance & Huether, 2014). The patient had also reported she recently recovered from the influenza viral infection. The autoimmune component of Guillain-Barre is thought to be triggered after a viral or bacterial infection (McCance & Huether, 2014).
Differential Diagnosis III – Systemic Lupus Erythematosus (SLE)
Figure 3. Systemic lupus erythematosus (Starkebaum, 2017)
Rationale:
The patient’s age and gender at symptom onset are in line with the typical diagnosis of lupus. Lupus is more common in females (10:1 ratio) between ages of 20 and 40- years-old (McCance & Huether, 2014). The complaint of double vision and pain behind the eye can indicate optic neuritis, which is common in SLE (Brownlee, Hardy, Fazekas, & Miller, 2016). The episodic patterns of symptoms coincide with SLE in the fact that is a relapse-remitting disease process (McCance & Huether, 2014).