Differential Diagnosis

• Single most likely diagnosis:
  • A. Cerebral stroke (recurred) - This is the most likely diagnosis given the patient's history of a previous stroke. The recurrence of stroke is a significant concern in patients with a history of cerebrovascular disease, and the CNS manifestations could be indicative of a new stroke event.
• Other Likely diagnoses:
  • B. Hydatid cyst in the brain - Although hydatid disease is rare in Mexico, it cannot be ruled out entirely, especially if the patient had exposure to the parasite during travel. CNS involvement can occur, presenting with a variety of symptoms including seizures, headaches, and focal neurological deficits.
  • C. Amoebic brain abscess - This is a possibility, especially considering the patient's travel history to Mexico, where amoebic infections can be more common. Amoebic brain abscesses are rare but can present with CNS manifestations similar to those described.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Neurocysticercosis - Given the patient's travel to Mexico, neurocysticercosis, caused by the pork tapeworm (Taenia solium), is a critical diagnosis not to miss. It can present with a wide range of neurological symptoms and can be life-threatening if not treated properly.
  • CNS infections (e.g., toxoplasmosis, fungal infections) - These infections can have severe consequences if not diagnosed and treated promptly, especially in immunocompromised patients or those with a history of stroke.
• Rare diagnoses:
  • Other parasitic infections (e.g., Chagas disease, if the patient had specific exposures) - While rare, these infections can occur in travelers and must be considered based on the patient's exposure history.
  • Primary brain tumors or metastases - Although less likely given the acute presentation, these cannot be entirely ruled out without further diagnostic workup, including imaging and potentially biopsy.