Differential Diagnosis for 75 yo Male with Neurological Symptoms

The patient's symptoms of right lower lip numbness, right hand numbness and tingling, left-sided headache, and balance issues suggest a complex neurological presentation that could be indicative of a stroke or Transient Ischemic Attack (TIA). The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Lateral Medullary Syndrome (Wallenberg's Syndrome): This condition, caused by a stroke in the posterior inferior cerebellar artery or vertebral artery, can lead to symptoms such as numbness of the face (including the lip), numbness or tingling in the extremities (like the hand), headache, and balance issues due to cerebellar involvement. The crossed pattern of symptoms (e.g., left headache with right-sided numbness) is characteristic.
• Other Likely Diagnoses
  • Posterior Circulation Stroke: Strokes in the posterior circulation (vertebrobasilar system) can cause a variety of symptoms including numbness, tingling, headaches, and balance problems. The symptoms can be diverse and depend on the specific area affected.
  • Lacunar Stroke: Although lacunar strokes typically present with pure motor or pure sensory strokes, some lacunar syndromes can cause a combination of symptoms that might fit this patient's presentation, especially if the stroke affects areas responsible for sensory processing and balance.
• Do Not Miss Diagnoses
  • Brainstem Stroke: A stroke in the brainstem can have devastating consequences and may present with a variety of symptoms including numbness, weakness, cranial nerve deficits, and balance issues. Early recognition is crucial.
  • Cerebellar Hemorrhage or Infarct: While less common, a hemorrhage or large infarct in the cerebellum can cause sudden onset of headache, balance issues, and potentially life-threatening complications due to brainstem compression or hydrocephalus.
• Rare Diagnoses
  • Multiple Sclerosis (MS) or Acute Disseminated Encephalomyelitis (ADEM): Although less likely in a 75-year-old, these demyelinating diseases can present with a wide range of neurological symptoms including numbness, tingling, and balance issues. However, the acute onset and specific combination of symptoms in this case make them less probable.
  • Neurosyphilis: This condition can cause a variety of neurological symptoms, but it is relatively rare and would be considered a diagnosis of exclusion after more common causes have been ruled out.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic tests such as imaging studies (e.g., MRI) to determine the underlying cause of the symptoms.