Differential Diagnosis for Occluded Left Middle Cerebral Artery
- Single Most Likely Diagnosis
- Atherosclerotic Occlusion: This is the most common cause of cerebral artery occlusion, especially in older adults. The presence of an occluded left middle cerebral artery with collateral refilling suggests a possible atherosclerotic plaque causing the blockage.
- Other Likely Diagnoses
- Cardioembolic Occlusion: This could be due to a cardiac source of embolism, such as atrial fibrillation, leading to the occlusion of the left middle cerebral artery.
- Dissection of the Left Middle Cerebral Artery: Although less common, dissection could lead to occlusion, especially if there's a history of trauma or certain connective tissue disorders.
- Do Not Miss Diagnoses
- Vasculitis (e.g., Giant Cell Arteritis, Primary Central Nervous System Vasculitis): These conditions can cause inflammation of the blood vessels, leading to occlusion. Missing these diagnoses could result in delayed treatment and significant morbidity.
- Moyamoya Disease: A rare condition causing narrowing or blockage of the internal carotid artery and its branches, which could lead to the occlusion seen in the left middle cerebral artery.
- Rare Diagnoses
- Fibromuscular Dysplasia: A rare condition that affects the medium and large arteries, most often the renal and internal carotid arteries, but could potentially affect the middle cerebral artery.
- Vasospasm: Typically seen in the context of subarachnoid hemorrhage, but could be a consideration if there's a history suggestive of such an event.
- Neurosyphilis: A rare cause of cerebral vasculitis that could lead to occlusion, especially in the absence of other risk factors for atherosclerosis or cardioembolism.