Differential Diagnosis for Arterial Dehiscence or Aneurysm in Neck Causing Dizziness and Facial Numbness

Single Most Likely Diagnosis

• Vertebrobasilar Insufficiency: This condition, which affects the blood supply to the brainstem, cerebellum, and parts of the brain, can cause dizziness and facial numbness due to decreased blood flow. The symptoms presented could be indicative of a transient or chronic reduction in blood flow through the vertebrobasilar system, possibly due to an aneurysm or dehiscence affecting these arteries.

Other Likely Diagnoses

• Carotid Artery Dissection or Aneurysm: These conditions can lead to decreased blood flow to parts of the brain, including areas responsible for balance and facial sensation, thus causing dizziness and facial numbness.
• Stroke or Transient Ischemic Attack (TIA): Although more commonly associated with sudden onset of focal neurological deficits, a stroke or TIA in certain brain areas could present with dizziness and facial numbness.
• Temporal Arteritis: Inflammation of the temporal artery can lead to decreased blood flow and cause a variety of symptoms including dizziness and facial pain or numbness, especially in older adults.

Do Not Miss Diagnoses

• Subarachnoid Hemorrhage: Although typically presenting with a severe headache, a subarachnoid hemorrhage due to an aneurysm rupture can sometimes have more subtle initial symptoms, including dizziness and facial numbness, making it crucial not to miss this potentially life-threatening condition.
• Cervical Artery Dissection: Dissection of the carotid or vertebral arteries can lead to stroke or other neurological deficits and is a critical diagnosis to consider in patients with neck pain and neurological symptoms.

Rare Diagnoses

• Fibromuscular Dysplasia: A rare condition that affects the medium and large arteries, most commonly the renal and internal carotid arteries, which could potentially cause the symptoms described if it involves the carotid or vertebral arteries.
• Ehlers-Danlos Syndrome: A group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues, which can increase the risk of arterial aneurysms or dehiscence, though it would be an uncommon cause of the specific symptoms described.
• Takayasu Arteritis: A rare form of large vessel vasculitis that can affect the aorta and its major branches, potentially leading to decreased blood flow and neurological symptoms if the carotid or vertebral arteries are involved.