Differential Diagnosis for Patient with History of TIA Presenting with Isolated Motor and Sensory Symptoms of R Lower Extremity
- Single most likely diagnosis
- Stroke (specifically, lacunar stroke): Given the patient's history of TIA and the presentation of isolated motor and sensory symptoms in one lower extremity, a lacunar stroke is a strong consideration. Lacunar strokes often result from small vessel disease and can present with pure motor or sensory symptoms.
- Other Likely diagnoses
- Peripheral neuropathy: This could be a consideration, especially if the patient has a history of diabetes or other conditions that predispose to neuropathy. However, the acute onset and specific involvement of one lower extremity might lean more towards a vascular cause.
- Radiculopathy: A nerve root lesion could cause motor and sensory symptoms in a lower extremity. The distribution of symptoms would depend on the specific nerve root involved.
- Spinal cord infarction: Although less common, spinal cord infarction could present with acute onset of motor and sensory symptoms in the lower extremities, depending on the level of the infarct.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal epidural hematoma or abscess: These conditions are emergencies that require prompt diagnosis and treatment. They can present with acute onset of neurological deficits, including motor and sensory symptoms in the lower extremities.
- Cauda equina syndrome: This is a serious condition that requires immediate attention. It can result from a variety of causes, including disc herniation, and presents with low back pain, sciatica, and neurological deficits in the lower extremities.
- Aortic dissection: Although it might not directly cause isolated lower extremity symptoms, aortic dissection can lead to spinal cord or peripheral nerve ischemia, presenting with acute neurological deficits.
- Rare diagnoses
- Multiple sclerosis: An acute relapse could present with focal neurological deficits, including motor and sensory symptoms in one lower extremity. However, the history of TIA and the specific presentation might make this less likely.
- Vasculitis (e.g., giant cell arteritis, primary CNS vasculitis): These conditions can cause stroke or spinal cord infarction but are less common and would typically be associated with other systemic symptoms.
- Mitochondrial disorders: Certain mitochondrial myopathies can present with stroke-like episodes, but these would be rare and typically associated with other systemic or muscular symptoms.