Differential Diagnosis for Left Visual Deficit and Ataxia in an 87-Year-Old Patient with AVR and CABG x 3

Single Most Likely Diagnosis

• Cerebrovascular Accident (CVA) or Stroke: Given the patient's history of cardiovascular surgeries (AVR and CABG x 3) and age, a stroke is a highly plausible cause for the sudden onset of left visual deficit and ataxia. The patient's vascular history increases the risk of cerebrovascular events.

Other Likely Diagnoses

• Transient Ischemic Attack (TIA): Similar to a CVA, but symptoms are temporary, lasting less than 24 hours. The patient's symptoms could be a TIA, which is a warning sign for a future stroke.
• Vascular Dementia: Although less likely to present acutely, given the patient's age and vascular history, vascular dementia could contribute to ataxia and visual disturbances over time.
• Cardiac Embolism: The patient's history of heart surgery increases the risk of cardiac embolism, which could lead to cerebral embolic events causing the symptoms.

Do Not Miss Diagnoses

• Posterior Circulation Stroke: This includes strokes affecting the brainstem, cerebellum, and posterior cerebral arteries, which can present with ataxia and visual field defects. Missing this diagnosis could lead to inappropriate management and increased morbidity.
• Subarachnoid Hemorrhage: Although less common, a subarachnoid hemorrhage can present with sudden neurological deficits, including ataxia and visual disturbances. It is critical to diagnose promptly due to its high mortality rate.
• Giant Cell Arteritis: This condition can cause visual disturbances and, less commonly, ataxia if there is involvement of the posterior circulation. Given the patient's age, it is a diagnosis that should not be missed due to its treatable nature with steroids.

Rare Diagnoses

• Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can cause a range of neurological symptoms, including ataxia and visual disturbances. It is much less likely but should be considered in the differential diagnosis due to its distinct management and prognosis.
• Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS): A rare mitochondrial disorder that can cause stroke-like episodes, including visual disturbances and ataxia. It is more common in younger patients but should be considered in atypical stroke presentations.
• Cerebral Vasculitis: Inflammation of the blood vessels in the brain, which can cause a variety of neurological symptoms, including ataxia and visual disturbances. It is rare and would require specific diagnostic tests for confirmation.