Differential Diagnosis for 80M Vasculopath with Headache and Tinnitus
Single Most Likely Diagnosis
- Giant Cell Arteritis (GCA): This is the most likely diagnosis given the patient's age, symptoms of headache, and elevated ESR. GCA is a large vessel vasculitis that commonly presents with headache, scalp tenderness, and visual disturbances, although tinnitus can also be a symptom. The absence of acute pathology on non-contrast CT brain and the significantly elevated ESR further support this diagnosis.
Other Likely Diagnoses
- Temporal Arteritis: Similar to GCA, temporal arteritis can present with headache and elevated inflammatory markers. It's a form of vasculitis affecting the medium and large arteries, particularly those in the head.
- Vasculitis (other forms): Other forms of vasculitis, such as polyarteritis nodosa or granulomatosis with polyangiitis, could also present with similar symptoms, although they might have additional systemic manifestations.
- Migraine or Tension Headache: Although less likely given the elevated ESR, these common headache disorders could still be considered, especially if the patient has a history of such conditions.
Do Not Miss Diagnoses
- Vertebrobasilar Insufficiency or Stroke: Although the non-contrast CT brain did not show acute pathology, it's crucial not to miss a stroke or vertebrobasilar insufficiency, especially given the patient's vasculopathy and symptoms that could indicate posterior circulation involvement.
- Intracranial Aneurysm or Arteriovenous Malformation (AVM): These conditions could present with sudden onset of headache and might not always show up on a non-contrast CT. They are critical to diagnose due to their potential for severe consequences.
- Meningitis: Infection should always be considered, especially in the elderly, as meningitis can present with headache and elevated inflammatory markers.
Rare Diagnoses
- Cogan Syndrome: A rare disorder characterized by recurrent corneal inflammation and vestibular-auditory symptoms, which could include tinnitus. It's associated with vasculitis and could be considered in this context.
- Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Although rare, it could potentially explain some of the patient's symptoms, especially if there's a history of easy bruising, poor wound healing, or joint hypermobility.
- Primary Central Nervous System Vasculitis (PCNSV): A rare form of vasculitis that exclusively affects the blood vessels of the brain and spinal cord. It could present with a variety of neurological symptoms, including headache and possibly tinnitus, although it's much less common than other diagnoses listed here.