Differential Diagnosis
- Single most likely diagnosis
- E) Vertebrobasilar insufficiency: This diagnosis is the most likely due to the patient's symptoms of spinning vertigo, facial and upper extremity numbness, and slurred speech, which are consistent with transient ischemic attacks (TIAs) in the vertebrobasilar distribution. The presence of bilateral supraclavicular and carotid bruits also suggests atherosclerotic disease, which could lead to vertebrobasilar insufficiency.
- Other Likely diagnoses
- C) Carotid stenosis: Although the patient's symptoms are more suggestive of vertebrobasilar insufficiency, carotid stenosis could still be a possible diagnosis, especially given the presence of carotid bruits. However, the symptoms of vertigo and numbness on one side of the face are less typical for carotid stenosis.
- D) Thalamic infarction: A thalamic infarction could cause sensory deficits, but it would not typically cause vertigo or the specific pattern of symptoms seen in this patient.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None specifically identified: However, it is essential to consider other potential causes of stroke or TIA, such as cardiac embolism or vasculitis, even if they are less likely based on the patient's presentation.
- Rare diagnoses
- A) Acoustic neuroma: This diagnosis is unlikely, as it would typically cause unilateral hearing loss, tinnitus, and balance problems, but not the transient episodes of vertigo and numbness seen in this patient.
- B) Benign positional vertigo: This condition causes brief episodes of vertigo triggered by specific head movements, which does not match the patient's symptoms.
- F) Vestibulitis: This is an inflammatory condition of the vestibular system, which could cause vertigo, but it would not explain the patient's other symptoms, such as facial numbness and slurred speech.