Differential Diagnosis for a 55-year-old man with bilateral arm numbness and transient visual spots

• Single most likely diagnosis:
  • Transient Ischemic Attack (TIA): This condition is characterized by temporary symptoms similar to those of a stroke, which resolve within 24 hours. The symptoms of bilateral arm numbness and transient visual disturbances could indicate a TIA, especially given the transient nature of the symptoms.
• Other Likely diagnoses:
  • Migraine with Aura: Migraines can cause visual disturbances (aura) and sometimes numbness or tingling in the arms. Although migraines are more common in women, men can also experience them.
  • Multiple Sclerosis (MS): MS is an autoimmune disease that affects the brain and spinal cord, leading to a wide range of neurological symptoms, including numbness, vision problems, and other sensory issues. The optic neuritis associated with MS could explain the visual spots.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Stroke: Although the symptoms have resolved, it's crucial to rule out a stroke, as prompt treatment is essential for preventing further brain damage. The resolution of symptoms does not exclude the possibility of a stroke, especially if it was a small one.
  • Giant Cell Arteritis: This condition involves inflammation of the arteries and can lead to visual disturbances, including transient vision loss. It's a medical emergency because it can cause permanent blindness if not treated promptly.
  • Vertebrobasilar Insufficiency: This condition involves poor blood flow in the posterior circulation of the brain, which can cause a variety of symptoms, including visual disturbances and numbness. It's a precursor to a potential stroke in the posterior circulation.
• Rare diagnoses:
  • Mitochondrial Myopathies: These are a group of disorders caused by mutations in the mitochondria, affecting muscle and nerve cells. Some types can cause stroke-like episodes, including visual and sensory symptoms.
  • CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): This is a rare, hereditary condition that affects the blood vessels in the brain, leading to subcortical strokes and dementia. It could present with migraine-like episodes and stroke-like symptoms.