Differential Diagnosis for 68M with Slurred Speech and Right Arm Weakness 3 Hours Post Fall
- Single most likely diagnosis:
- Ischemic Stroke: The patient's symptoms of slurred speech and right arm weakness are classic presentations of a stroke, particularly an ischemic stroke, which occurs when a blood vessel supplying blood to the brain is obstructed. The timing of these symptoms appearing 3 hours post fall suggests a possible stroke, as falls can sometimes be a cause or a result of stroke, or the fall might have been coincidental but the stroke symptoms became apparent afterward.
- Other Likely diagnoses:
- Intracranial Hemorrhage (ICH): Given the history of a fall, there's a possibility of head trauma leading to an intracranial hemorrhage, which could present with similar symptoms if the hemorrhage is located in an area affecting motor and speech functions.
- Traumatic Brain Injury (TBI): The fall could have resulted in a TBI, which might cause symptoms like slurred speech and arm weakness due to the direct injury to the brain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Subarachnoid Hemorrhage (SAH): Although less common, a SAH could occur due to the fall, especially if there was significant head trauma. It's crucial to consider SAH because it requires immediate intervention.
- Spinal Cord Injury: If the fall resulted in a spinal cord injury, it could lead to neurological deficits, including weakness. Early recognition and management are critical to prevent further damage.
- Status Epilepticus: Post-traumatic seizures could present with focal neurological deficits, and status epilepticus is a medical emergency that requires prompt treatment.
- Rare diagnoses:
- Hemiplegic Migraine: A rare condition that could mimic stroke symptoms, including hemiparesis and speech disturbances, but is typically accompanied by a headache.
- Multiple Sclerosis (MS) or Acute Disseminated Encephalomyelitis (ADEM): Although less likely, these demyelinating diseases could present with sudden onset of neurological deficits, including speech and motor symptoms, but are rare in the context of a recent fall.