Differential Diagnosis for 75 yo Male with Right Lower Lip Numbness, Right Hand Numbness, Tingling, and Left Sided Headache

• Single Most Likely Diagnosis
  • Stroke (specifically, a lacunar stroke or a stroke affecting the brainstem or the contralateral hemisphere of the brain): This is the most likely diagnosis given the combination of unilateral facial numbness, unilateral limb numbness/tingling, and headache. The symptoms suggest a vascular event affecting the brain.
• Other Likely Diagnoses
  • Transient Ischemic Attack (TIA): Similar to a stroke but temporary, TIAs are "mini-strokes" that resolve within 24 hours. The symptoms presented could be indicative of a TIA, especially if they are transient.
  • Multiple Sclerosis (MS): Although less common in a 75-year-old due to the typical age of onset, MS could present with a wide range of neurological symptoms, including numbness and tingling in different parts of the body, and could be considered, especially if there are other episodes or symptoms suggestive of demyelination.
  • Peripheral Neuropathy: This condition could cause numbness and tingling in the hand but would less likely explain the lip numbness and headache unless it's part of a more complex neuropathic syndrome.
• Do Not Miss Diagnoses
  • Brain Tumor: A tumor in the brain could cause focal neurological deficits, including numbness and tingling, depending on its location. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
  • Subarachnoid Hemorrhage or Other Intracranial Hemorrhages: These are medical emergencies that could present with sudden headache and focal neurological deficits. Immediate diagnosis and treatment are critical.
  • Giant Cell Arteritis: This condition, which causes inflammation of the blood vessels, can lead to headache and, if involving the vertebral or carotid arteries, could potentially cause neurological symptoms. It's a diagnosis that should not be missed due to the risk of vision loss and stroke.
• Rare Diagnoses
  • Sjögren's Syndrome: An autoimmune disorder that could cause neuropathy among its wide range of symptoms, including numbness and tingling, though it would be less likely to cause such localized and acute symptoms.
  • Lyme Disease (Neuroborreliosis): In endemic areas, Lyme disease can cause neurological symptoms, including numbness, tingling, and headache, though it's less common in the elderly and would typically be accompanied by other symptoms like rash or fever.
  • Vasculitis (e.g., CNS Vasculitis): Inflammation of the blood vessels within the brain could cause a variety of neurological symptoms, including those described, but is relatively rare and would likely be accompanied by systemic symptoms.