Differential Diagnosis for 60 yo with rt sided numbness and SOB
- Single most likely diagnosis:
- Acute Ischemic Stroke: The patient's symptoms of right-sided numbness are consistent with a stroke, and the shortness of breath (SOB) could be related to the stress of the event or a pre-existing condition. The sudden onset of numbness is a classic presentation for a stroke.
- Other Likely diagnoses:
- Transient Ischemic Attack (TIA): Similar to a stroke but with symptoms lasting less than 24 hours. The patient's 2-day history of numbness could be a TIA, but given the duration, a stroke is more likely.
- Pulmonary Embolism (PE): While SOB is a key symptom of PE, the right-sided numbness doesn't directly correlate. However, a large PE could lead to decreased mobility and increase the risk of stroke or TIA.
- Chronic Obstructive Pulmonary Disease (COPD) exacerbation: Could explain the SOB but not the numbness unless the patient has a pre-existing neurological condition.
- Do Not Miss diagnoses:
- Myocardial Infarction (MI): Although the primary symptom is numbness, MI can sometimes present atypically, especially in older adults, and can lead to decreased cardiac output, potentially causing neurological symptoms.
- Aortic Dissection: A life-threatening condition that could cause both SOB and neurological symptoms if the dissection involves the carotid arteries.
- Subarachnoid Hemorrhage: A severe headache is typically the primary symptom, but it can also cause sudden neurological deficits and could potentially lead to SOB due to increased intracranial pressure or stress response.
- Rare diagnoses:
- Multiple Sclerosis (MS): An autoimmune disease that can cause numbness but typically has a more gradual onset and is less likely to present with acute SOB.
- Vasculitis (e.g., Giant Cell Arteritis): Could cause both neurological symptoms and SOB if there's involvement of the respiratory system, but it's less common and usually accompanied by other symptoms like headache or jaw claudication.
- Mitochondrial Myopathies: Rare genetic disorders that can cause a wide range of symptoms including muscle weakness and shortness of breath, but the acute onset of unilateral numbness would be unusual.