Differential Diagnosis for Severe Global Right Sided Weakness
Single Most Likely Diagnosis
- Cerebral Infarction (Ischemic Stroke): The patient's history of atrial fibrillation (AF) and current anticoagulation with warfarin, combined with the sudden onset of severe global right-sided weakness, strongly suggests an ischemic stroke, likely due to an embolic event originating from the heart.
Other Likely Diagnoses
- Cerebral Hemorrhage: Although the patient is on warfarin, which increases the risk of bleeding, the sudden onset of focal neurological deficits is more suggestive of a hemorrhagic stroke, especially if the international normalized ratio (INR) is elevated.
- ** Stroke Mimic (e.g., Hemiparkinsonism, Infection, or Migraine)**: Conditions that can mimic stroke symptoms, such as hemiparkinsonism, infections, or migraines, should be considered, especially if there are atypical features or an unclear history.
- ** Cervical Spine Injury or Herniation**: A cervical spine injury or herniation could cause acute weakness, but this would typically be accompanied by neck pain, trauma history, or other symptoms.
Do Not Miss Diagnoses
- Cervical Artery Dissection: A dissection of the cervical arteries (carotid or vertebral) can lead to ischemic stroke and must be considered, especially if there's a history of trauma or neck pain.
- ** Brain Tumor or Mass Lesion**: Although less likely, a brain tumor or mass lesion could cause acute focal neurological deficits, especially if there's a history of cancer or other suggestive symptoms.
- ** Infection (e.g., Abscess, Encephinfoarditis)**: Central nervous system infections, such as brain abscesses or encephinfoarditis, can present with acute neurological deficits and must be considered, especially if there are signs of infection or immunocompromised state.
Rare Diagnoses
- ** Vasculitis (e.g., Giant Cell Arteritis)**: Vasculitis, such as giant cell arteritis, can cause stroke-like symptoms, but this is relatively rare and typically accompanied by other systemic symptoms.
- ** Mitochondrial Encepharmopathy, Lactic Acidosis, and Stroke-like episodes (MELAS)**: This rare genetic disorder can cause stroke-like episodes, but it's typically seen in younger patients with a history of developmental delays or other systemic symptoms.