Differential Diagnosis
- Single most likely diagnosis
- Aneurysm: The CT scan of the head showing a 5 mm bar-like appearance of the blood vessel at the arterial bifurcation of the proximal circle of Willis is highly suggestive of an aneurysm. The patient's symptoms of worsening headaches, double vision, neck tightness, and tingling sensation in one side of the face are also consistent with an aneurysm, particularly one that is expanding or pressing on nearby structures.
- Other Likely diagnoses
- Hypertensive Encephalopathy: Given the patient's history of hypertension and non-adherence to medication, hypertensive encephalopathy is a possible diagnosis. The patient's high blood pressure and symptoms of headache and visual disturbances are consistent with this condition.
- Cervicogenic Headache: The patient's complaint of neck tightness and the presence of degenerative changes in the cervical spine on x-ray suggest that cervicogenic headache could be a contributing factor to the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid Hemorrhage: Although the CT scan does not show evidence of bleeding, subarachnoid hemorrhage is a potentially life-threatening condition that must be considered in the differential diagnosis of sudden-onset headache.
- Stroke: Given the patient's family history of stroke and his own history of hypertension and smoking, stroke is a possible diagnosis that must be considered, particularly if the patient's symptoms worsen or if new symptoms develop.
- Rare diagnoses
- Arteriovenous Malformation (AVM): Although less likely, AVM is a possible diagnosis that could explain the patient's symptoms and the abnormal appearance of the blood vessel on the CT scan.
- Moyamoya Disease: This rare condition, characterized by narrowing or blockage of the internal carotid artery and its branches, could potentially explain the patient's symptoms, but it is less likely given the patient's age and lack of other characteristic symptoms.