Differential Diagnosis for Periorbital Swelling in a Patient with Acute Stroke
- Single most likely diagnosis: + Allergic reaction to Plavix: The patient's symptoms of periorbital swelling that resolved with Benadryl, an antihistamine, suggest an allergic reaction. Given that the patient is known to tolerate aspirin well, the new introduction of Plavix makes it a prime suspect for the allergic reaction.
- Other Likely diagnoses: + Angioedema: This could be related to either the stroke itself or a side effect of one of the medications, though the resolution with Benadryl leans more towards an allergic reaction. + Stroke-related edema: In the context of an acute stroke, facial or periorbital swelling could potentially occur due to the stroke's effects on the body, though this would be less likely to resolve quickly with antihistamines.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.): + Anaphylaxis: Although the symptoms seem mild and resolved with Benadryl, any sign of an allergic reaction, especially in the context of new medication, should prompt consideration of anaphylaxis, a potentially life-threatening condition. + Cerebral edema: In the setting of an acute stroke, any new onset of swelling, even if it appears to be periorbital, should prompt consideration of cerebral edema, which can be life-threatening and requires immediate medical attention.
- Rare diagnoses: + Plavix-induced thrombotic thrombocytopenic purpura (TTP): This is a rare but serious condition associated with certain medications, including Plavix. It would present with thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms, which are not mentioned here. + Stroke mimics with allergic components: Certain conditions that mimic stroke, such as hypertensive encephalopathy or posterior reversible encephalopathy syndrome (PRES), could potentially present with facial swelling, though these would be less likely to resolve with antihistamines alone.