Differential Diagnosis for Syncope with Nonspecific Foci of High T2 Signal on Brain MRI
Single Most Likely Diagnosis
- Migraine with aura: This condition can cause syncope and is often associated with nonspecific white matter lesions on MRI, which may appear as high T2 signal foci. Migraines are relatively common and can explain both the neurological symptoms and the imaging findings.
Other Likely Diagnoses
- Multiple Sclerosis (MS): MS can present with a wide range of neurological symptoms, including syncope, and is characterized by lesions in the white matter of the brain that appear as high T2 signal foci on MRI. The disease is more common in young adults.
- Vasovagal Syncope with incidental MRI findings: Vasovagal syncope is a common cause of fainting spells and may not be directly related to the MRI findings. The high T2 signal foci could be incidental and unrelated to the syncope.
- Small Vessel Disease: This condition affects the small blood vessels in the brain and can lead to white matter lesions visible on MRI. It could potentially cause syncope, although this is less common.
Do Not Miss Diagnoses
- Brain Tumors: Although less likely, it's crucial not to miss brain tumors, which can cause both syncope (through increased intracranial pressure or direct brainstem involvement) and appear as high T2 signal lesions on MRI.
- Cerebral Venous Thrombosis: This is a potentially life-threatening condition that can cause a variety of neurological symptoms, including syncope, and may show high T2 signal lesions on MRI due to venous infarction.
- Central Nervous System Vasculitis: This inflammatory condition affecting the blood vessels of the brain can cause a wide range of symptoms, including syncope, and may show nonspecific lesions on MRI.
Rare Diagnoses
- Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS): A rare mitochondrial disorder that can cause stroke-like episodes, seizures, and potentially syncope, with characteristic lesions on MRI that may appear as high T2 signal foci.
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A rare hereditary condition leading to stroke and dementia, characterized by white matter lesions on MRI, which could potentially cause syncope.
- Neurodegenerative diseases with vascular components: Certain neurodegenerative diseases can have vascular components that lead to white matter lesions and potentially syncope, though these would be rare causes.