Differential Diagnosis for 75-year-old Female with Sturred Speech
Single Most Likely Diagnosis
- Transient Ischemic Attack (TIA): Given the patient's history of hypertension, benign coronary artery disease, and hypercholesterolemia, along with the symptoms of stuttered speech, weakness, and dizziness that resolved within 40 minutes, a TIA is the most likely diagnosis. The presence of chronic microvascular ischemic changes and a chronic lacunar infarct on the CT head also supports this diagnosis.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): The patient's urinalysis shows positive nitrite, leukocyte esterase, and many bacteria, indicating a UTI. While this may not directly cause stuttered speech, it could contribute to the patient's overall condition, especially if the infection is severe or has spread to the bloodstream.
- Dehydration or Electrolyte Imbalance: Although the patient's BMP shows relatively stable electrolyte levels, dehydration or an electrolyte imbalance could contribute to the patient's symptoms, especially dizziness and nausea.
- Medication Side Effect: The patient's past medical history includes hypertension, coronary artery disease, and hypercholesterolemia, for which she may be taking medications. Some of these medications could potentially cause side effects like dizziness, nausea, or even speech disturbances.
Do Not Miss Diagnoses
- Stroke: Although the CT head shows no acute intracranial abnormality, it is crucial to consider the possibility of a stroke, especially given the patient's symptoms. A stroke could be ischemic or hemorrhagic, and some types, like a lacunar stroke, might not be immediately visible on a CT scan.
- Seizure: A seizure could cause transient speech disturbances, weakness, and dizziness. Given the patient's age and medical history, it is essential to consider this possibility, even if the patient does not have a history of seizure disorders.
- Intracranial Hemorrhage: Although less likely given the CT head results, an intracranial hemorrhage could present with sudden onset of speech disturbances, weakness, and other neurological symptoms.
Rare Diagnoses
- Multiple Sclerosis or Other Demyelinating Diseases: These conditions could cause speech disturbances, weakness, and dizziness, but they are less likely given the patient's age and the acute onset of symptoms.
- Vasculitis or Other Vascular Diseases: Conditions like giant cell arteritis or primary central nervous system vasculitis could cause stroke-like symptoms, but they are rare and would require further investigation to diagnose.
- Meningitis or Encephalitis: Although the patient's symptoms do not strongly suggest an infection of the central nervous system, and the CSF analysis is not provided, these conditions could cause a wide range of neurological symptoms, including speech disturbances.