Differential Diagnosis
- Single most likely diagnosis
- G) Subdural hematoma: This is the most likely diagnosis given the patient's age, history of falls, and symptoms of disorientation, left-sided neglect, and mild left hemiparesis. The presence of increased deep tendon reflexes and a positive Babinski sign on the left side also suggests a right-sided intracranial lesion, which is consistent with a subdural hematoma.
- Other Likely diagnoses
- E) Parasagittal meningioma: This diagnosis is possible given the patient's symptoms of headaches, disorientation, and left-sided weakness. Meningiomas are more common in older adults and can cause focal neurologic deficits.
- F) Pituitary adenoma: Although less likely, a pituitary adenoma could cause headaches and visual disturbances, but it would not typically cause unilateral neglect or hemiparesis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- G) Subdural hematoma (also listed as the single most likely diagnosis): It is crucial to consider this diagnosis due to the patient's history of falls and the potential for rapid deterioration.
- B) Craniopharyngioma: Although rare, craniopharyngiomas can cause increased intracranial pressure, visual disturbances, and hormonal imbalances. They can be life-threatening if not diagnosed and treated promptly.
- Rare diagnoses
- C) Medulloblastoma: This is a rare brain tumor that typically occurs in children, making it an unlikely diagnosis in a 77-year-old woman.
- A) Cluster headache and D) Migraine: These are primary headache disorders that do not typically cause disorientation, neglect, or hemiparesis, making them unlikely diagnoses in this case.