Differential Diagnosis for 54-year-old with Right Sided Weakness
Single Most Likely Diagnosis
- Ischemic Stroke: Given the patient's history of hypertension (HTN) and the sudden onset of right-sided weakness, ischemic stroke is the most likely diagnosis. The symptoms started yesterday and worsened today, which is consistent with the progression of a stroke.
Other Likely Diagnoses
- Intracerebral Hemorrhage: Although less common than ischemic stroke, intracerebral hemorrhage is a possible cause of sudden weakness, especially in a patient with a history of hypertension.
- Transient Ischemic Attack (TIA): If the patient's symptoms are fluctuating or have resolved, a TIA could be considered, although the worsening of symptoms over time makes this less likely.
- Hemorrhagic Transformation of Ischemic Stroke: This is a possible complication of ischemic stroke, where the ischemic area converts into a hemorrhage, which could explain worsening symptoms.
Do Not Miss Diagnoses
- Subarachnoid Hemorrhage: Although less likely, subarachnoid hemorrhage is a critical diagnosis that must not be missed due to its high mortality rate. It typically presents with sudden, severe headache, but can also cause focal neurological deficits.
- Spinal Cord Infarction or Hemorrhage: These conditions can present with acute weakness and are medical emergencies that require prompt diagnosis and treatment.
- Meningitis or Encephalitis: Infections of the central nervous system can cause a wide range of symptoms, including focal weakness, and are critical to diagnose early due to their potential for severe morbidity and mortality.
Rare Diagnoses
- Cerebral Venous Thrombosis: This is a less common cause of stroke that can present with a variety of symptoms, including focal weakness, and is more common in patients with hypercoagulable states or other specific risk factors.
- Arteriovenous Malformation (AVM) or Arterial Aneurysm: These vascular abnormalities can cause hemorrhagic strokes and are important to consider, especially if imaging studies are inconclusive for other diagnoses.
- Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS): A rare genetic disorder that can cause stroke-like episodes, particularly in younger patients, but could be considered in atypical cases.