Differential Diagnosis I – Multiple Sclerosis
Figure 1. Myelin damage and the nervous system (Mayo Clinic, 2017)
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)
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)
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).