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: Post-ictal confusion and weakness could explain the patient's presentation. The slurred speech could be a result of the seizure itself or the post-ictal phase.
- Hypoglycemia: Although the patient's vitals are stable, hypoglycemia can cause confusion, slurred speech, diaphoresis, and weakness. The presence of a device with a connecting white wire on the hand could suggest an insulin pump or a glucose monitoring device.
- Infection (Meningitis or Encephalitis): While less likely given the lack of fever or specific meningeal signs, infections affecting the central nervous system can present with acute confusion and neurological deficits.
Do Not Miss Diagnoses
- Hyperkalemia or Cardiac Ischemia: Although the ECG in the field was normal, cardiac issues can rapidly evolve. Hyperkalemia can cause muscle weakness and cardiac arrhythmias, which might not always be immediately evident on an ECG.
- Wernicke's Encephalopathy: This condition, caused by thiamine deficiency, can present with confusion, ataxia, and ophthalmoplegia. It's a medical emergency that requires immediate treatment.
- Poisoning or Toxicity: Various toxins can cause confusion, slurred speech, and weakness. The diaphoretic skin could suggest cholinergic or sympathomimetic toxicity.
Rare Diagnoses
- Mitochondrial Myopathies: Certain mitochondrial disorders can present with episodes of weakness and neurological symptoms, though these are less common and typically have a more chronic course.
- Hashimoto's Encephalopathy: A rare condition associated with Hashimoto's thyroiditis, characterized by acute or subacute encephalopathy. It's an important diagnosis to consider in patients with unexplained neurological symptoms and thyroid disease.
- Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can present with rapidly progressive dementia, though it typically has a more subacute onset.