Differential Diagnosis for Nonresolving Intermittent Dry Cough since Stroke

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): A common condition that can cause a dry cough, especially in patients who have experienced a stroke, as they may have swallowing difficulties or decreased mobility that exacerbates reflux.
• Post-stroke Aspiration: Patients post-stroke are at risk for aspiration due to dysphagia, which can lead to a chronic cough.

Other Likely Diagnoses

• Asthma or Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Conditions that can cause a chronic cough, and their symptoms might have been exacerbated or unmasked by the stroke.
• Pulmonary Embolism: Although less common, it's a possibility, especially if the patient has been immobile post-stroke, increasing the risk of deep vein thrombosis and subsequent pulmonary embolism.
• Infections (e.g., Pneumonia): Recurrent or chronic infections can occur, especially in patients with compromised swallowing mechanisms or those who are bedridden.

Do Not Miss Diagnoses

• Lung Cancer: Although less likely, it's crucial not to miss, especially if the patient has a history of smoking or other risk factors. A chronic cough can be an early symptom.
• Pulmonary Tuberculosis: Another critical diagnosis not to miss, especially in patients with risk factors such as immunocompromised states or exposure history.
• Cardiac Failure: Can cause a chronic cough, especially if there's pulmonary congestion. This is particularly relevant in the context of a stroke, as cardiac conditions can be both a cause and a consequence of stroke.

Rare Diagnoses

• Sarcoidosis: A systemic disease that can cause a dry cough among other symptoms, though it's less common.
• Interstitial Lung Disease: Conditions such as idiopathic pulmonary fibrosis can cause a dry cough, though they are less likely and typically have other accompanying symptoms.
• Foreign Body Aspiration: Though more common in children, adults, especially those post-stroke with dysphagia, can also aspirate foreign bodies, leading to a chronic cough.

Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and appropriate diagnostic tests to determine the underlying cause of the nonresolving intermittent dry cough.