Differential Diagnosis for 60 yo Male with Sudden Onset Headache, Inability to Walk, and Loss of Balance

• Single Most Likely Diagnosis

  • Cerebellar Stroke: The sudden onset of headache, inability to walk, and loss of balance in a 60-year-old male strongly suggests a cerebellar stroke. The cerebellum is responsible for coordination and balance, and a stroke in this area can lead to ataxia (loss of coordination) and difficulty walking.

• Other Likely Diagnoses

  • Vestibular Migraine: Although less common in men, vestibular migraines can cause sudden onset of headache, vertigo, and imbalance. The symptoms can mimic those of a stroke, making diagnosis challenging.
  • Benign Paroxysmal Positional Vertigo (BPPV): While BPPV typically causes vertigo and not headache, in some cases, it can lead to severe vertigo that might be mistaken for imbalance or difficulty walking, especially if the patient is elderly and has other comorbidities.
  • Inner Ear Infection (Labyrinthitis): An inner ear infection can cause severe vertigo, imbalance, and sometimes headache, though the headache is usually not the predominant symptom.

• Do Not Miss Diagnoses

  • Subarachnoid Hemorrhage: A sudden, severe headache (often described as "the worst headache of my life") with or without other symptoms like loss of balance could be indicative of a subarachnoid hemorrhage, which is a medical emergency.
  • Posterior Circulation Stroke (including Brainstem Stroke): Strokes in the posterior circulation or brainstem can present with a variety of symptoms including sudden onset headache, vertigo, imbalance, and difficulty walking. These strokes can be particularly dangerous due to their location and potential to affect critical brain areas.
  • Meningitis: Although less likely, meningitis can present with headache, fever, and sometimes neurological deficits including balance problems. It's a diagnosis that cannot be missed due to its high mortality rate if not treated promptly.

• Rare Diagnoses

  • Acoustic Neuroma: A benign tumor on the nerve connecting the inner ear to the brain can cause balance problems and headache, but this would typically be a more gradual onset.
  • Multiple Sclerosis: An initial episode of multiple sclerosis (a demyelinating disease) could potentially present with sudden onset of neurological symptoms including balance problems and headache, though this is less common.
  • Cerebellar Hemangioblastoma: A rare tumor of the cerebellum that could cause symptoms due to compression or bleeding, presenting with headache, ataxia, and balance difficulties.