Differential Diagnosis for Left Hemiparesis with Left Facial Palsy

Single Most Likely Diagnosis

• Stroke (Ischemic or Hemorrhagic): The combination of left hemiparesis and left facial palsy is highly suggestive of a stroke, particularly one affecting the right hemisphere of the brain, which could involve the motor cortex or the internal capsule, leading to these symptoms.

Other Likely Diagnoses

• Brain Tumor: A tumor in the right hemisphere of the brain could compress or invade areas responsible for motor function and facial nerve control, leading to hemiparesis and facial palsy.
• Cerebral Vasculitis: Inflammation of the blood vessels in the brain could lead to ischemia or infarction in areas responsible for motor control and facial function.
• Multiple Sclerosis: Although less common, multiple sclerosis could present with a relapse involving the motor pathways and facial nerve, leading to these symptoms.

Do Not Miss Diagnoses

• Brain Abscess: An abscess in the brain could present with focal neurological deficits, including hemiparesis and facial palsy, and is critical to diagnose due to the need for urgent antibiotic treatment and possible surgical intervention.
• Subdural or Epidural Hematoma: Bleeding outside the brain could compress brain tissue, leading to focal neurological deficits, and requires immediate diagnosis and surgical intervention to prevent further brain damage or death.
• Cerebral Venous Thrombosis: A clot in the veins of the brain could lead to ischemia or infarction, presenting with a variety of symptoms including hemiparesis and facial palsy, and is crucial to diagnose due to the need for anticoagulation therapy.

Rare Diagnoses

• Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS): A rare genetic disorder that can cause stroke-like episodes, including hemiparesis and facial weakness.
• Neurosyphilis: A rare condition caused by syphilis infection of the brain, which can lead to a variety of neurological symptoms, including hemiparesis and facial palsy.
• Rasmussen's Encephalitis: A rare inflammatory neurological disease, often affecting one hemisphere of the brain, leading to progressive hemiparesis, seizures, and other focal neurological deficits.