Differential Diagnosis for 75 yo Male with Neurological Symptoms

The patient's symptoms of right lower lip numbness, right hand numbness and tingling, and left-sided headache with balance issues suggest a complex neurological condition. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Stroke or Transient Ischemic Attack (TIA): The combination of unilateral facial numbness, contralateral limb numbness, and headache with balance issues could indicate a stroke or TIA, particularly in the brainstem or involving the posterior circulation. The age of the patient and the nature of the symptoms make this a highly plausible diagnosis.

• Other Likely Diagnoses

  • Multiple Sclerosis (MS): Although less common in new onset at 75, MS could present with a wide range of neurological symptoms, including numbness and balance issues. However, the age and the specific pattern of symptoms might make this less likely.
  • Neuropathy: Diabetic neuropathy or other forms of peripheral neuropathy could cause numbness and tingling, but the unilateral headache and balance issues would be less typical.
  • Trigeminal Neuralgia: Could explain the facial numbness but would not typically cause hand numbness or balance issues.

• Do Not Miss Diagnoses

  • Brain Tumor: A tumor in the brainstem or cerebellum could cause the described symptoms, including cranial nerve deficits, limb numbness, and balance issues. Although less common, missing this diagnosis could be catastrophic.
  • Subarachnoid Hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") could be accompanied by other neurological symptoms, including numbness and balance issues, due to blood irritating the nerves.
  • Temporal Arteritis: Given the patient's age, temporal arteritis (giant cell arteritis) could present with headache and, less commonly, neurological symptoms due to ischemic optic neuropathy or other cranial nerve involvement.

• Rare Diagnoses

  • Lyme Disease: Neurological manifestations of Lyme disease can include meningitis, encephalitis, and neuropathy, which might present with a variety of symptoms, including numbness and headache.
  • Sjögren's Syndrome: This autoimmune disorder can cause neuropathy and might rarely present with the combination of symptoms described, although it would be an unusual initial presentation.
  • Vitamin Deficiency (e.g., B12 deficiency): Can cause neurological symptoms, including numbness and balance issues, but the specific pattern and unilateral nature of the symptoms would be less typical.