Differential Diagnosis for Plain Cranial CT Scan Result of Diabetic and Hypertensive Patient

Given the context of a diabetic and hypertensive patient, the differential diagnosis for abnormalities seen on a plain cranial CT scan can be categorized as follows:

• Single Most Likely Diagnosis
  • Cerebral Infarction (Ischemic Stroke): This is a common complication in patients with hypertension and diabetes due to atherosclerosis and small vessel disease. The CT scan might show areas of low attenuation indicating ischemia or infarction.
• Other Likely Diagnoses
  • Intracerebral Hemorrhage: Hypertension is a significant risk factor for intracerebral hemorrhage. The CT scan would typically show a hyperdense area indicating fresh blood.
  • Diabetic Cerebral Small Vessel Disease: Diabetes can lead to small vessel disease in the brain, manifesting as white matter hyperintensities or lacunar infarcts on CT, though these might be more subtle.
• Do Not Miss Diagnoses
  • Subarachnoid Hemorrhage: Although less common, subarachnoid hemorrhage due to aneurysmal rupture or other causes can be catastrophic if missed. The CT scan might show hyperdensity in the subarachnoid spaces.
  • Venous Sinus Thrombosis: This condition, though less common, can be associated with diabetes and dehydration. CT venography might be needed for diagnosis, but initial clues could be seen on a non-contrast CT.
• Rare Diagnoses
  • Cerebral Vasculitis: This is an inflammation of the blood vessels in the brain and can be associated with various systemic diseases. It's rare but could present with non-specific findings on CT, such as multiple infarcts in different vascular territories.
  • Malignant Hypertension-related Posterior Reversible Encephalopathy Syndrome (PRES): Though more commonly associated with severe hypertension, this condition can also occur in the context of diabetic and hypertensive emergencies, showing bilateral parieto-occipital white matter edema on CT.

Each of these diagnoses has a different set of implications for patient management, emphasizing the importance of a thorough diagnostic approach. The justification for each diagnosis is based on the patient's risk factors (diabetes and hypertension) and the typical presentations of these conditions on a plain cranial CT scan.