Differential Diagnosis
The patient's presentation of sudden weakness and loss of sensation over the left side of the body, along with decreased sense of smell, hearing, and taste on the left side, and inability to move the left side of the face or extremities, suggests a neurological cause. Here are the possible diagnoses categorized:
- Single most likely diagnosis
- E) Right hemispheric stroke: The patient's symptoms, including sudden onset of weakness, loss of sensation, and decreased vision on one side of the body, are consistent with a stroke. The fact that the patient has a history of hypertension, which is a risk factor for stroke, further supports this diagnosis.
- Other Likely diagnoses
- C) Intraparenchymal hematoma: Although the collision was at a low speed, it is still possible that the patient suffered a head injury that resulted in an intraparenchymal hematoma. The patient's symptoms could be due to increased intracranial pressure or direct damage to the brain tissue.
- B) Focal seizure with postictal Todd paralysis: The patient's sudden onset of weakness and loss of sensation could be due to a focal seizure, and the subsequent Todd paralysis could explain the prolonged weakness.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Intraparenchymal hematoma: As mentioned earlier, an intraparenchymal hematoma could be a life-threatening condition that requires immediate attention.
- E) Right hemispheric stroke: A stroke is a medical emergency that requires prompt treatment to minimize damage and improve outcomes.
- Rare diagnoses
- A) Conversion disorder: This is a psychological condition that could present with neurological symptoms, but it is less likely given the patient's acute presentation and lack of previous psychological history.
- D) Postconcussion syndrome: Although the patient was involved in a motor vehicle collision, the symptoms described are not typical of postconcussion syndrome, which usually includes headache, dizziness, and difficulty concentrating.
- F) Somatic symptom disorder: This is a psychological condition that involves excessive thoughts, feelings, or behaviors related to somatic symptoms, but it is unlikely given the patient's acute presentation and lack of previous psychological history.