Differential Diagnosis for Embolic Episode
The patient's symptoms suggest a complex neurological presentation involving multiple cranial nerves and sensory pathways. Here's a breakdown of the differential diagnosis:
- Single most likely diagnosis
- Posterior Inferior Cerebellar Artery (PICA): The combination of ipsilateral limb and gait ataxia, Horner's syndrome, and tremor, with contralateral limb dysmetria and loss of pain and temperature, points towards a lesion in the lateral medulla, which is typically supplied by the PICA. The involvement of multiple cranial nerves and the specific pattern of sensory loss also support this diagnosis.
- Other Likely diagnoses
- Vertebrobasilar Artery: A lesion in the vertebrobasilar artery could explain the patient's symptoms, given its supply to the brainstem and cerebellum. However, the specific pattern of symptoms might not be as typical for a vertebrobasilar artery lesion as for a PICA lesion.
- Anterior Inferior Cerebellar Artery: While less likely than PICA, a lesion in this artery could also result in some of the patient's symptoms, particularly those related to cerebellar dysfunction.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Basilar Artery Occlusion: Although less likely given the specific pattern of symptoms, basilar artery occlusion is a medical emergency that can lead to locked-in syndrome or death if not promptly treated. It's crucial to consider this diagnosis, even if the symptoms don't perfectly align.
- Rare diagnoses
- Superior Cerebellar Artery: A lesion in this artery could result in some cerebellar symptoms but would not typically cause the full range of symptoms described, particularly the contralateral loss of pain and temperature.
- Posterior Cerebral Artery: This artery's occlusion would more likely result in symptoms related to the occipital lobe and would not explain the brainstem and cerebellar findings in this patient.
Each of these diagnoses is considered based on the pattern of symptoms and the vascular territories involved. The justification for each is grounded in the anatomical correlation between the symptoms presented and the areas of the brain supplied by the respective arteries.