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Differential Diagnosis

  • Single most likely diagnosis:
    • Giant Cell Arteritis (GCA): The patient's symptoms, including visual loss, jaw discomfort, and headache, along with the presence of a left parieto-occipital infarction and significant left subclavian artery stenosis, are suggestive of GCA. The elevated platelet count and response to prednisone further support this diagnosis.
  • Other Likely diagnoses:
    • Atherosclerosis: The patient's history of smoking and significant left subclavian artery stenosis suggest atherosclerotic disease, which could contribute to her symptoms.
    • Takayasu Arteritis: Although the TABS (Takayasu Arteritis Biomarkers Score) is not mentioned, the patient's age and sex, along with the presence of subclavian artery stenosis, could suggest Takayasu arteritis. However, the lack of systemic symptoms and normal ESR/CRP make this less likely.
  • Do Not Miss diagnoses:
    • Aortic Dissection: Although less likely, given the patient's symptoms and the presence of subclavian artery stenosis, aortic dissection could be a life-threatening condition that needs to be ruled out.
    • Vasculitis (e.g., ANCA-associated vasculitis): The patient's symptoms and response to prednisone could also suggest other forms of vasculitis, which would require further evaluation.
  • Rare diagnoses:
    • Ehlers-Danlos Syndrome: This genetic disorder could increase the risk of vascular complications, including subclavian artery stenosis and aneurysms.
    • Fibromuscular Dysplasia: A rare vascular disease that could cause subclavian artery stenosis and other vascular complications.

Next Steps

The patient's response to prednisone and hydroxyurea suggests that GCA is the most likely diagnosis. However, further evaluation, including:

  • Temporal artery biopsy to confirm GCA
  • Imaging studies (e.g., MRA or CTA) to evaluate the extent of vascular involvement
  • Regular monitoring of platelet count and inflammatory markers
  • Adjustments to the patient's medication regimen as needed would be necessary to confirm the diagnosis and guide management.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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