Differential Diagnosis for Right Facial Dropping and Void of Words
Single most likely diagnosis
- Middle Cerebral Artery (MCA) occlusion: The MCA supplies a significant portion of the lateral surface of the brain, including the areas responsible for facial movement (motor cortex) and language (Broca's area for expressive aphasia and Wernicke's area for receptive aphasia). A blockage in this artery could lead to contralateral facial weakness (drooping) and aphasia (void of words), making it the most likely diagnosis given the symptoms.
Other Likely diagnoses
- Anterior Cerebral Artery (ACA) occlusion: Although less likely than MCA occlusion for the described symptoms, ACA occlusion can cause contralateral lower limb weakness and, in some cases, affect speech if the area of the brain responsible for language is involved, particularly if the dominant hemisphere is affected.
- Posterior Cerebral Artery (PCA) occlusion: PCA occlusion typically presents with visual field defects, but in rare cases, it can affect areas involved in language processing, especially if there's significant variability in cerebral vascular anatomy. However, facial drooping is less commonly associated with PCA occlusions.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vertebral or Basilar Artery occlusion: While these arteries primarily supply the posterior circulation, including the brainstem and cerebellum, a large vertebral or basilar artery occlusion can have widespread effects, including cranial nerve palsies that could mimic facial drooping and significant neurological deficits. Missing this diagnosis could be catastrophic due to the potential for brainstem involvement.
- Carotid Artery occlusion: A complete occlusion of the carotid artery can lead to a decrease in blood flow to the entire anterior circulation of the brain, potentially causing a combination of symptoms including facial drooping and aphasia, depending on the areas affected.
Rare diagnoses
- Lacunar stroke: Small vessel disease can lead to lacunar infarcts, which are small strokes in the deeper parts of the brain. While they typically present with pure motor or sensory strokes, in rare cases, they can cause a combination of symptoms that might include facial weakness and language disturbances if the infarct is strategically located.
- Moyamoya disease: A rare condition caused by narrowing or blockage of the internal carotid artery and its branches, leading to a reduction in blood flow to the brain. It can present with a variety of symptoms, including stroke, and might rarely cause the combination of facial drooping and language difficulties described.