Differential Diagnosis for the Vertebral Angiogram Abnormality

The abnormality marked by "X" on the vertebral angiogram of a 40-year-old man suggests a vascular issue affecting the brain. Given the location and the nature of the imaging, the clinical findings can be correlated with potential diagnoses based on the area of the brain affected by the vascular anomaly.

• Single Most Likely Diagnosis

  • Ataxic limb movements (B): This is likely due to a vascular malformation or anomaly affecting the cerebellum or its connections, which are supplied by the vertebral and basilar arteries. Ataxia would result from damage to these areas, leading to coordination and balance issues.

• Other Likely Diagnoses

  • Spastic hemiparesis (D): If the abnormality affects the motor pathways (corticospinal tracts) in the brainstem or the cerebellar connections, it could lead to weakness and increased reflexes on one side of the body.
  • Visual field defect (E): Depending on the exact location and the structures affected by the vascular anomaly, visual field defects could occur, especially if the anomaly impacts the visual pathways in the brainstem or the occipital lobe.

• Do Not Miss Diagnoses

  • Aphasia (A): Although less likely given the vertebral angiogram's focus, if the anomaly has a significant impact on the posterior circulation affecting the dominant hemisphere's language areas indirectly, aphasia could be a presenting symptom. It's crucial not to miss this diagnosis due to its significant impact on communication.
  • Resting tremor (C): This could be associated with Parkinson's disease or other parkinsonian syndromes, which might not be directly related to a vascular anomaly. However, in the context of a vertebral angiogram, considering the brainstem's involvement is essential, as it could affect motor control.

• Rare Diagnoses

  • Brainstem stroke or syndromes: These are less common but could present with a wide range of symptoms depending on the exact location and extent of the brainstem affected. Symptoms could include cranial nerve palsies, ataxia, and even respiratory issues.
  • Arteriovenous malformation (AVM) or arteriovenous fistula (AVF): These vascular anomalies could lead to a variety of neurological symptoms depending on their location and the structures they affect. They are less common but important to consider due to their potential for significant morbidity if ruptured or if they cause steal phenomena.