Differential Diagnosis for New Onset Headaches with Subcentimeter Foci of T2/FLAIR Hyperintensity
- Single Most Likely Diagnosis
- Migraines with migrainous infarcts or chronic small vessel ischemic changes: This is a common condition that can cause headaches and white matter changes on MRI due to chronic small vessel disease or migrainous infarcts.
- Other Likely Diagnoses
- Multiple Sclerosis (MS): MS is an autoimmune disease that can cause demyelination in the central nervous system, leading to white matter lesions and a variety of neurological symptoms, including headaches.
- Chronic Small Vessel Ischemic Changes: These changes are common in older adults and can be associated with hypertension, diabetes, and other vascular risk factors, leading to white matter hyperintensities on MRI.
- Migraine with Aura: Some patients with migraines may have white matter lesions on MRI, possibly due to migrainous infarcts or other mechanisms.
- Do Not Miss Diagnoses
- Central Nervous System (CNS) Vasculitis: This is a rare but potentially life-threatening condition that can cause headaches, white matter lesions, and other neurological symptoms due to inflammation of blood vessels in the brain.
- CNS Lymphoma: This is a type of cancer that can cause white matter lesions, headaches, and other neurological symptoms, and requires prompt diagnosis and treatment.
- Progressive Multifocal Leukoencephalopathy (PML): This is a rare and often fatal viral infection that can cause white matter lesions and neurological symptoms in immunocompromised patients.
- Rare Diagnoses
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): This is a rare genetic disorder that can cause white matter lesions, headaches, and other neurological symptoms due to chronic small vessel disease.
- Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS): This is a rare mitochondrial disorder that can cause white matter lesions, headaches, and other neurological symptoms due to mitochondrial dysfunction.
- Neurosarcoidosis: This is a rare condition that can cause white matter lesions, headaches, and other neurological symptoms due to granulomatous inflammation in the brain.