Differential Diagnosis for Dizziness, Uncoordinated Gait, and Rambling Speech with Negative CT for Acute Stroke

• Single Most Likely Diagnosis
  • Vestibular Disorder (e.g., Vestibular Neuritis or Benign Paroxysmal Positional Vertigo): Given the symptoms of dizziness and uncoordinated gait, a vestibular disorder is a plausible explanation. These conditions often present with vertigo, imbalance, and sometimes speech difficulties due to the associated nausea and discomfort.
• Other Likely Diagnoses
  • Inner Ear Infection (Labyrinthitis): This condition can cause dizziness, imbalance, and hearing or speech difficulties, aligning with the patient's symptoms.
  • Medication Side Effects: Certain medications can cause dizziness, ataxia (uncoordinated gait), and alterations in speech, especially in elderly patients or those with polypharmacy.
  • Alcohol Intoxication or Withdrawal: Alcohol can cause slurred speech, ataxia, and dizziness, and its withdrawal can lead to similar symptoms, along with more severe neurological manifestations.
• Do Not Miss Diagnoses
  • Posterior Circulation Stroke or Transient Ischemic Attack (TIA): Although the CT is negative for acute stroke, posterior circulation strokes (involving the vertebrobasilar system) can sometimes be missed on initial imaging. These strokes can present with ataxia, vertigo, and speech difficulties.
  • Wernicke's Encephalopathy: This condition, caused by thiamine deficiency, can present with ataxia, ophthalmoplegia, and confusion or altered mental status, which might be mistaken for rambling speech. It's a medical emergency requiring prompt treatment.
  • Multiple Sclerosis or Acute Demyelinating Syndrome: These conditions can cause a wide range of neurological symptoms, including ataxia, speech difficulties, and dizziness, especially if there are lesions in the cerebellum or brainstem.
• Rare Diagnoses
  • Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can cause ataxia, speech difficulties, and a variety of other neurological symptoms.
  • Cerebellar Degeneration: Conditions that cause progressive damage to the cerebellum can result in ataxia, speech difficulties (dysarthria), and other coordination problems.
  • Mitochondrial Disorders: Certain mitochondrial myopathies can present with neurological symptoms, including ataxia and speech difficulties, due to the high energy demands of the brain and nervous system.