Differential Diagnosis for Hallucinations and Truncal Ataxia in a 65-Year-Old Female
Single Most Likely Diagnosis
- Wernicke's Encephalopathy: This condition, caused by thiamine deficiency, often presents with the classic triad of confusion, ataxia, and ophthalmoplegia, but hallucinations can also be a feature. Given the age and potential for poor nutrition or alcohol abuse, this diagnosis is highly plausible.
Other Likely Diagnoses
- Alzheimer's Disease with Psychotic Features: While more commonly associated with memory loss, Alzheimer's can present with hallucinations. Truncal ataxia could be a sign of advanced disease affecting balance and coordination.
- Lewy Body Dementia: Characterized by fluctuations in cognitive function, visual hallucinations, and parkinsonian motor symptoms, which could include ataxia.
- Vitamin B12 Deficiency: Can cause neurological symptoms including ataxia and, in some cases, psychiatric symptoms like hallucinations due to its role in the synthesis of myelin and neurotransmitters.
Do Not Miss Diagnoses
- Cerebellar Stroke or Hemorrhage: Although less common, a stroke or hemorrhage in the cerebellum can cause sudden onset of ataxia and, depending on the area affected, could lead to hallucinations due to increased intracranial pressure or direct brainstem involvement.
- Brain Metastases: Especially from lung, breast, or melanoma primaries, which can cause a variety of neurological symptoms depending on their location, including ataxia and hallucinations.
- Multiple Sclerosis: Although less typical in a 65-year-old female due to the age of onset, MS can present with almost any neurological symptom, including ataxia and hallucinations, especially in the context of a relapse.
Rare Diagnoses
- Creutzfeldt-Jakob Disease: A prion disease that can present with rapid cognitive decline, ataxia, and visual hallucinations, though it's exceedingly rare.
- Hashimoto's Encephalopathy: An autoimmune condition associated with Hashimoto's thyroiditis, which can cause a wide range of neurological symptoms, including ataxia and hallucinations, but is relatively rare and diagnosis can be challenging.
- Whipple's Disease: A systemic bacterial infection that can cause neurological symptoms, including ataxia and hallucinations, but is very rare and usually presents with gastrointestinal symptoms.