Differential Diagnosis
- Single most likely diagnosis
- Posterior Reversible Encephalopathy Syndrome (PRES): Given the patient's history of intracranial bleeding, residual hemiplegia, and current symptoms of lethargy, bradycardia, and hypothermia, PRES is a possible diagnosis. The fact that the CT head didn't show any new or worsening bleeding and the EEG revealed no seizure activity also points towards a condition that affects the brain globally rather than a focal lesion.
- Other Likely diagnoses
- Cerebral Vasospasm: This condition can occur after intracranial bleeding and can cause symptoms such as lethargy, bradycardia, and hypothermia. The absence of new bleeding on the CT head doesn't rule out vasospasm, as it can occur without visible changes on imaging.
- Hydrocephalus: The patient's history of intracranial bleeding increases the risk of developing hydrocephalus, which can cause symptoms such as lethargy, bradycardia, and hypothermia.
- Medication-induced Encephalopathy (e.g., Keppra): Although the patient is on Keppra for seizure prophylaxis, it's possible that the medication is contributing to the patient's lethargy and altered mental status.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Rebleeding or Rupture of a Vascular Malformation: Although the CT head didn't show any new or worsening bleeding, it's essential to consider the possibility of rebleeding or rupture of a vascular malformation, as this would be a life-threatening condition.
- Infection (e.g., Meningitis, Encephalitis): Infections can cause symptoms such as lethargy, bradycardia, and hypothermia, and can be deadly if not promptly diagnosed and treated.
- Brainstem Injury: The patient's symptoms of lethargy, bradycardia, and hypothermia could be indicative of a brainstem injury, which would be a critical condition to identify.
- Rare diagnoses
- Central Hypothyroidism: This condition can cause symptoms such as lethargy, bradycardia, and hypothermia, although it's a rare diagnosis in this context.
- Adrenal Insufficiency: Although rare, adrenal insufficiency can cause symptoms such as lethargy, bradycardia, and hypothermia, and would be a critical condition to identify.