Differential Diagnosis for 75-year-old with Slurred Speech
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI) with possible sepsis or delirium: The patient's urinalysis shows positive nitrite, leukocytes, WBC 21-50, and many bacteria, indicating a UTI. In elderly patients, UTIs can present with non-specific symptoms such as slurred speech, confusion, or altered mental status due to sepsis or delirium.
Other Likely Diagnoses
- Stroke or Transient Ischemic Attack (TIA): Although the CT head does not show acute intracranial hemorrhage, the presence of chronic microvascular ischemic changes and a chronic lacunar infarct in the left thalamus suggests a history of cerebrovascular disease. The patient's slurred speech could be a sign of a new or recurrent stroke or TIA.
- Dementia or Alzheimer's disease: The CT head shows age-related cerebral and cerebellar volume loss, which could be indicative of dementia or Alzheimer's disease. Slurred speech can be a symptom of these conditions, especially in advanced stages.
- Medication side effects: The patient's age and potential polypharmacy increase the risk of medication side effects, such as sedatives, anticholinergics, or other medications that can cause slurred speech.
Do Not Miss Diagnoses
- Subdural hematoma or other intracranial hemorrhage: Although the CT head does not show acute intracranial hemorrhage, it is essential to consider this possibility, especially if the patient has a history of falls or trauma.
- Meningitis or encephalitis: Infection of the central nervous system can present with non-specific symptoms, including slurred speech, and requires prompt diagnosis and treatment.
- Brain tumor: A brain tumor can cause slurred speech, especially if it is located in areas responsible for language processing.
Rare Diagnoses
- Creutzfeldt-Jakob disease: This rare prion disease can cause rapidly progressive dementia, including slurred speech, but the CT head does not show specific findings, and prion studies are not available.
- Amyotrophic lateral sclerosis (ALS): This rare neurodegenerative disease can cause progressive speech and language difficulties, including slurred speech, but other symptoms such as muscle weakness and atrophy would be expected.
- Multiple sclerosis: This autoimmune disease can cause a range of neurological symptoms, including slurred speech, but the CT head does not show characteristic lesions, and other symptoms such as optic neuritis or sensory deficits would be expected.