Differential Diagnosis for Sudden Onset of Loss of Vision
- Single most likely diagnosis
- A) Amyloid deposition in the media and adventitia of small cerebral arteries: This is the most likely cause given the patient's age and the sudden onset of homonymous hemianopia. Amyloid angiopathy can lead to cerebral vasculature changes, increasing the risk of ischemic events or hemorrhages, which could explain the visual field defect.
- Other Likely diagnoses
- B) Atherosclerotic narrowing of the left middle cerebral artery: Given the patient's history of a previous cerebral hemorrhage and the presence of homonymous hemianopia, atherosclerotic disease affecting the posterior cerebral artery or its branches could be a plausible explanation, although less likely than amyloid deposition in this context.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- E) Mycotic aneurysm rupture: Although less common, mycotic aneurysms can occur in the elderly, especially if there's an underlying infectious process. Rupture could lead to sudden visual loss among other symptoms, making it crucial not to miss this diagnosis.
- F) Vasculitis of the central nervous system: This is a potentially treatable condition that could present with sudden visual loss. Missing this diagnosis could lead to significant morbidity or mortality.
- Rare diagnoses
- C) Fibromuscular dysplasia: This condition is more commonly associated with younger patients and typically affects the renal or internal carotid arteries. It's less likely in this elderly patient but could be considered in the differential for unexplained vascular events.
- D) Hyperplasia of the tunica media vasorum: This is a rare condition and not commonly associated with the clinical presentation described, making it an unlikely cause of the patient's symptoms.