Differential Diagnosis for Right Hemiplegia
The patient's presentation of right hemiplegia, dense flaccid paralysis involving the right side of the face and extremities, normal sensation, and presence of Babinski sign on the right suggests a lesion in the central nervous system. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Internal capsule (E): The internal capsule is a common site for ischemic strokes, which can cause contralateral hemiplegia due to its dense concentration of motor fibers. The patient's history of hypertension increases the risk of stroke, making this a likely diagnosis.
- Other Likely diagnoses
- Basal ganglia (A): A lesion in the basal ganglia, such as a lacunar stroke, can cause contralateral hemiplegia. However, the involvement of the face, arm, and leg equally suggests a more posterior lesion.
- Brain stem (B): Although brainstem lesions can cause hemiplegia, they often involve cranial nerve deficits and ataxia, which are not present in this case.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal cord (F): A spinal cord lesion, such as a spinal cord infarction or hemorrhage, can cause bilateral or unilateral weakness. However, the absence of sensory deficits makes this less likely.
- Rare diagnoses
- Cerebellum (C): Cerebellar lesions typically cause ataxia, dysarthria, and nystagmus, rather than hemiplegia.
- Cervical root (D): A cervical root lesion would likely cause segmental weakness, sensory deficits, and reflex changes, which are not consistent with this patient's presentation.
In summary, the internal capsule is the most likely location for the lesion, given the patient's presentation and history of hypertension. However, it's essential to consider other possibilities, including basal ganglia and brainstem lesions, and not miss potentially life-threatening conditions like spinal cord lesions.