Differential Diagnosis for Stroke Syndrome with Vertigo and Left Facial Hypoesthesia
- Single most likely diagnosis:
- Lateral Medullary Syndrome (Wallenberg's Syndrome): This condition is caused by a stroke in the posterior inferior cerebellar artery or vertebral artery, affecting the lateral medulla. It classically presents with vertigo, ataxia, and crossed findings such as ipsilateral facial numbness (which could be perceived as hypoesthesia) and contralateral body numbness. The vertigo and facial hypoesthesia in the question align closely with the symptoms of Wallenberg's Syndrome.
- Other Likely diagnoses:
- Posterior Inferior Cerebellar Artery (PICA) Stroke: A stroke in the PICA territory can cause vertigo due to its supply to parts of the cerebellum involved in balance. While less specific than Wallenberg's Syndrome, it could potentially cause facial hypoesthesia if the stroke affects nearby areas or if there's variability in vascular supply.
- Brainstem Stroke (not specifically Wallenberg's): Strokes in other parts of the brainstem can also cause vertigo and facial hypoesthesia, depending on the exact location and structures affected. The brainstem's compact anatomy means that even small strokes can have significant and varied effects.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Basilar Artery Occlusion: While less common, an occlusion of the basilar artery can lead to a variety of brainstem and cerebellar symptoms, including vertigo and facial numbness. Given its potential for causing extensive brainstem infarction, it's crucial not to miss this diagnosis.
- Cerebellar Hemorrhage: A hemorrhage in the cerebellum can present with sudden onset vertigo, ataxia, and potentially facial hypoesthesia if it compresses or involves nearby brainstem structures. It's a medical emergency due to the risk of brainstem compression and hydrocephalus.
- Rare diagnoses:
- Vertebrobasilar Insufficiency: This condition involves transient symptoms due to decreased blood flow in the vertebrobasilar system, which could potentially include vertigo and facial hypoesthesia. It's less likely to cause persistent symptoms but is worth considering in the differential.
- Cerebellar Infarction in a Non-PICA Territory: Infarctions in other parts of the cerebellum might cause vertigo but are less likely to cause facial hypoesthesia directly. However, depending on the specific location and any potential edema or mass effect, it could indirectly cause such symptoms.