Differential Diagnosis for Acute Onset of Confusion in a Middle-Aged Man
Single Most Likely Diagnosis
- Stroke (Ischemic or Hemorrhagic): The acute onset of confusion, slurred speech, and diffuse weakness are classic signs of a stroke. The presence of these symptoms, especially the sudden inability to speak properly (aphasia), strongly suggests a cerebrovascular event.
Other Likely Diagnoses
- Seizure or Post-Ictal State: The confusion and slurred speech could be indicative of a seizure or the post-ictal phase following a seizure. The diaphoretic skin could also suggest a recent seizure activity.
- Metabolic Encephalopathy: Conditions such as hypoglycemia, hyperglycemia, or other metabolic disturbances could lead to confusion, weakness, and altered mental status.
- Infection (Meningitis or Encephalitis): Although less likely given the stable vitals, infections affecting the central nervous system could present with acute confusion and neurological deficits.
Do Not Miss Diagnoses
- Hypoglycemia: A potentially life-threatening condition that can cause confusion, slurred speech, and weakness. The presence of a device with a connecting white wire on the hand suggests the possibility of an insulin pump or a glucose monitoring device, making hypoglycemia a critical diagnosis not to miss.
- Wernicke's Encephalopathy: Caused by thiamine deficiency, often seen in alcoholics, but can also occur in other conditions leading to malnutrition. It's a medical emergency that requires immediate treatment.
- Subarachnoid Hemorrhage: Although the patient does not have a reported headache, a subarachnoid hemorrhage can present with sudden onset of confusion and should be considered due to its high mortality rate if missed.
Rare Diagnoses
- Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can present with rapid decline in neurological function, including confusion and speech difficulties.
- Hashimoto's Encephalopathy: A rare condition associated with Hashimoto's thyroiditis, presenting with encephalopathy and potentially other neurological symptoms.
- Reversible Posterior Leukoencephalopathy Syndrome (PRES): A rare condition characterized by headache, confusion, seizures, and visual disturbances, often associated with hypertension and certain medications.