Differential Diagnosis for Patient with Headaches after CVA

The patient's presentation of headaches following a cerebrovascular accident (CVA) with unknown cause, recent weakness in walking, and worsening vision necessitates a broad differential diagnosis to ensure all potential causes are considered. The differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis
  • Post-stroke headache with possible normal pressure hydrocephalus (NPH): This condition is a common cause of headache after a stroke and can also explain the gait disturbance and visual symptoms due to increased intracranial pressure or hydrocephalus.
• Other Likely Diagnoses
  • Post-stroke seizure: Seizures can occur after a stroke and may present with headaches, weakness, and visual disturbances.
  • Cerebral vasculitis: Inflammation of the blood vessels in the brain could lead to headaches, stroke-like symptoms, and visual disturbances.
  • Migraine or other primary headache disorders: These could be exacerbated by the stress of a stroke or could have an independent onset.
• Do Not Miss Diagnoses
  • Subarachnoid hemorrhage or other intracranial hemorrhage: Although the patient had a CVA, the possibility of a hemorrhagic stroke or an aneurysm rupture must be considered, especially with worsening symptoms.
  • Brain tumor: A tumor could cause increased intracranial pressure, leading to headaches, weakness, and visual disturbances.
  • Central nervous system infection (e.g., meningitis, encephalitis): Infections can present with a wide range of neurological symptoms, including headaches and visual disturbances.
• Rare Diagnoses
  • Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS): A rare genetic disorder that can cause stroke-like episodes, headaches, and visual disturbances.
  • Susac syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and cochlea, leading to headaches, visual disturbances, and hearing loss.
  • Reversible cerebral vasoconstriction syndrome (RCVS): A condition that can cause severe headaches and stroke-like symptoms due to vasoconstriction of the cerebral arteries.

Each of these diagnoses requires careful consideration and further investigation to determine the underlying cause of the patient's symptoms and to guide appropriate treatment.