Differential Diagnosis for 98 year old female with right eye nystagmus and past medical history of right sided CVA
- Single most likely diagnosis
- Stroke (specifically, a sequela of the previous right sided CVA): The patient's history of a right sided CVA increases the likelihood that the nystagmus is related to a stroke, possibly due to damage in the brainstem or cerebellum.
- Other Likely diagnoses
- Vestibular disorder (e.g., labyrinthitis, vestibular neuritis): These conditions can cause nystagmus and are relatively common in the elderly population.
- Cerebellar ataxia: Given the patient's age and history of CVA, cerebellar ataxia is a possible cause of nystagmus.
- Multiple sclerosis: Although less likely in a 98-year-old, multiple sclerosis can cause nystagmus and should be considered, especially if there are other neurological symptoms.
- Do Not Miss diagnoses
- Brain tumor (e.g., cerebellar or brainstem tumor): Although rare, a brain tumor could cause nystagmus and would be critical to diagnose due to its potential impact on treatment and prognosis.
- Wernicke's encephalopathy: This condition, caused by thiamine deficiency, can lead to nystagmus and is potentially life-threatening if not treated promptly.
- Posterior circulation stroke: A new stroke in the posterior circulation could cause nystagmus and is a critical diagnosis to consider due to its potential for severe consequences.
- Rare diagnoses
- Spinocerebellar ataxia: A group of genetic disorders that can cause cerebellar ataxia and nystagmus, although unlikely in a new presentation at 98 years old.
- Creutzfeldt-Jakob disease: A rare, degenerative neurological disorder that can cause nystagmus, although it would be unusual in this clinical context.
- Superior oblique myokymia: A rare condition characterized by intermittent, involuntary contractions of the superior oblique muscle, leading to nystagmus.