Differential Diagnosis for 70 yo with Recurrent CVA and Elevated IgM B2 Glycoprotein and Cardiolipid Antibody
- Single Most Likely Diagnosis
- Antiphospholipid Syndrome (APS): Although the patient has elevated IgM but not IgG antibodies against B2 glycoprotein and cardiolipin, APS is still a consideration due to the clinical presentation of recurrent CVA. The presence of these antibodies, even if not meeting the full criteria for APS, in the context of recurrent thrombotic events, makes APS a leading diagnosis.
- Other Likely Diagnoses
- Atherosclerotic Disease: Given the patient's age and history of recurrent CVA, atherosclerotic disease is a plausible cause, especially if other risk factors such as hypertension, diabetes, or hyperlipidemia are present.
- Cardiac Embolic Sources (e.g., Atrial Fibrillation): Even without a clear cardiac source identified on the initial work-up, the possibility of a cardiac embolic source, such as atrial fibrillation not detected during the initial evaluation, should be considered.
- Do Not Miss Diagnoses
- Vasculitis (e.g., Giant Cell Arteritis, Primary Central Nervous System Vasculitis): Although less common, vasculitis can cause recurrent strokes and must be considered to avoid missing a potentially treatable condition.
- Hypercoagulable States (e.g., Factor V Leiden, Protein C/S Deficiency): These conditions can increase the risk of thrombotic events and should be evaluated, especially in the context of recurrent CVA without another clear cause.
- Rare Diagnoses
- Sneddon Syndrome: A rare condition characterized by livedo reticularis and recurrent strokes, often associated with antiphospholipid antibodies.
- Susac Syndrome: A rare condition involving microangiopathy of the brain, retina, and inner ear, which could present with stroke-like symptoms.
- Fabry Disease: A genetic disorder that can lead to stroke due to vascular dysfunction, though it's more commonly associated with younger patients.
Each of these diagnoses requires careful consideration of the patient's clinical presentation, laboratory findings, and additional diagnostic testing as needed to determine the underlying cause of the recurrent CVAs.