Differential Diagnosis
The patient's symptoms of headache, numbness of the left lip and cheek, and balance issues can be attributed to various conditions. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Migraine with aura: The patient's symptoms of headache, numbness, and balance issues are consistent with a migraine with aura. The improvement of symptoms also supports this diagnosis, as migraines are often self-limiting.
- Other Likely diagnoses
- Trigeminal neuralgia: The patient's history of chronic sinusitis and numbness of the left lip and cheek could be related to trigeminal neuralgia, a condition characterized by sudden, severe facial pain.
- Hypertensive emergency: The patient's hypertension and sudden onset of headache could be indicative of a hypertensive emergency, which requires immediate attention.
- Multiple sclerosis: The patient's symptoms of numbness and balance issues could be related to multiple sclerosis, a chronic autoimmune disease affecting the central nervous system.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke or transient ischemic attack (TIA): Although the patient's symptoms have improved, it's essential to rule out a stroke or TIA, as these conditions can have devastating consequences if left untreated.
- Brain tumor: A brain tumor could cause the patient's symptoms, particularly the numbness and balance issues. Although less likely, this diagnosis should not be missed due to its potential severity.
- Temporal arteritis: This condition, characterized by inflammation of the blood vessels, can cause headache and facial pain, and is a medical emergency if left untreated.
- Rare diagnoses
- Lyme disease: Although less common, Lyme disease can cause neurological symptoms, including numbness and balance issues.
- Sarcoidosis: This rare autoimmune disease can affect the nervous system, causing symptoms such as numbness and balance issues.
- Vasculitis: Inflammation of the blood vessels can cause a range of symptoms, including headache and numbness, and is a rare but potentially serious condition.