Differential Diagnosis for Memory Recall Problems

Given the patient's presentation with normal GCS, respiratory, cardiovascular, and cognitive functions but difficulty with recall and short-term memory, along with a high D-dimer level, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Transient Global Amnesia (TGA): This condition is characterized by sudden, temporary memory loss and confusion, typically lasting a few hours. It's more common in middle-aged to elderly individuals. The high D-dimer could be incidental or related to a thrombotic event, but TGA is often idiopathic. TGA radiological findings are usually normal, but sometimes, small ischemic lesions can be seen on MRI.

• Other Likely Diagnoses

  • Minor Stroke or Transient Ischemic Attack (TIA): Although the patient's cardiovascular system is reported as normal, a minor stroke or TIA could cause memory issues. The high D-dimer might suggest a thrombotic event.
  • Migraine: Some migraines can present with aura symptoms that include memory disturbances and confusion. The high D-dimer could be unrelated or indicative of a migraine-related vasospasm.
  • Seizure: A seizure, particularly a complex partial seizure, could cause memory loss and confusion. However, other cognitive functions are usually affected as well.

• Do Not Miss Diagnoses

  • Venous Thromboembolism (VTE): A high D-dimer level is concerning for VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Although the respiratory and cardiovascular systems are reported as normal, these conditions can sometimes present subtly.
  • Encephalitis: Inflammation of the brain, often due to viral infections, can cause memory loss, confusion, and altered mental status. Early diagnosis is crucial for treatment.
  • Brain Tumor: Although less likely, a brain tumor could cause localized pressure effects leading to memory disturbances. Imaging would be critical in diagnosing this condition.

• Rare Diagnoses

  • Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can cause memory loss, behavioral changes, poor coordination, and visual disturbances.
  • Hashimoto's Encephalopathy: A rare condition associated with Hashimoto's thyroiditis, characterized by cognitive dysfunction, seizures, and stroke-like symptoms.
  • CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A rare, hereditary condition leading to stroke and dementia, typically presenting in mid-adult life.

Each of these diagnoses requires careful consideration of the patient's clinical presentation, laboratory findings, and imaging results to determine the most appropriate diagnosis and treatment plan.