Differential Diagnosis for Aphasic Patient with Right Hand Flaccid, Somnolent, Frustrated, and Tearful with Headache
- Single Most Likely Diagnosis
- Ischemic Stroke: Given the patient's aphasia, right hand flaccidness, and somnolence, an ischemic stroke is highly likely, especially with the presence of a small intracranial bleed on the CT scan, which could be a hemorrhagic transformation of an ischemic stroke.
- Other Likely Diagnoses
- Intracerebral Hemorrhage (ICH): Although the CT scan shows no mass effect, the small intracranial bleed could still be causing the patient's symptoms, and ICH is a possible diagnosis.
- Subarachnoid Hemorrhage (SAH): SAH could present with headache and altered mental status, and the small bleed on the CT scan could be a sign of SAH, although typically, SAH presents with more prominent headache and meningeal signs.
- Do Not Miss Diagnoses
- Brain Tumor with Hemorrhage: Although less likely, a brain tumor with hemorrhage could present with similar symptoms and would be catastrophic if missed.
- Arteriovenous Malformation (AVM) with Hemorrhage: An AVM with hemorrhage could also present with similar symptoms and would require urgent intervention.
- Infectious Causes (e.g., Brain Abscess, Encephalitis): Infectious causes could present with altered mental status, headache, and focal neurological signs, and would be deadly if missed.
- Rare Diagnoses
- Cerebral Vasculitis: A rare cause of stroke-like symptoms, cerebral vasculitis could present with similar symptoms, although it is less likely.
- Moyamoya Disease: A rare cause of stroke, Moyamoya disease could present with similar symptoms, especially in younger patients.
- Reversible Cerebral Vasoconstriction Syndrome (RCVS): RCVS could present with headache and altered mental status, although it is a rare diagnosis.