Differential Diagnosis for Darlene
Single Most Likely Diagnosis
- Vascular Dementia with Multifocal White Matter Disease: Given Darlene's history of severe multifocal white matter disease on CT, diffuse brain volume loss, and symptoms of dizziness, blackout episodes, weakness in legs, and recent changes in cognitive status, this diagnosis seems most plausible. The white matter disease and brain volume loss are indicative of vascular dementia, which can cause a range of cognitive and physical symptoms.
Other Likely Diagnoses
- Orthostatic Hypotension: Darlene's dizziness episodes that occur while standing, lying down, or sitting, and are severe enough to cause her to sit down, could be indicative of orthostatic hypotension, a condition where blood pressure drops upon standing.
- Seizure Disorder: The "blackout episodes" where Darlene feels like passing out and wakes up not recognizing her surroundings could be suggestive of a seizure disorder, particularly given the description of the room expanding and "a lot of stuff" going into her brain.
- Cardiac-Related Syncope: Given Darlene's history of arrhythmia (atrial fibrillation and atrial flutter), it's possible that her blackout episodes are related to cardiac issues, such as syncope due to arrhythmia.
Do Not Miss Diagnoses
- Transient Ischemic Attack (TIA) or Stroke: Although Darlene's symptoms have been ongoing for more than 8 months, it's crucial to consider the possibility of TIAs or strokes, especially given her history of arrhythmia and white matter disease. These conditions can have devastating consequences if missed.
- Intracranial Mass or Tumor: The complete opacification of the left maxillary sinus and Darlene's cognitive changes warrant consideration of an intracranial mass or tumor, which could be causing her symptoms.
- Infections (e.g., Sinusitis or Meningitis): Given the complete opacification of the left maxillary sinus, it's essential to rule out infections such as sinusitis or meningitis, which could be causing Darlene's symptoms.
Rare Diagnoses
- Normal Pressure Hydrocephalus (NPH): Although less likely, NPH could be considered given Darlene's symptoms of dizziness, weakness in legs, and cognitive changes. However, this diagnosis would require further evaluation, including imaging studies and potentially a lumbar puncture.
- Autoimmune or Inflammatory Disorders (e.g., Multiple Sclerosis or Vasculitis): These conditions are less likely given Darlene's age and presentation, but should be considered if other diagnoses are ruled out and her symptoms persist or worsen.