Differential Diagnosis for Romberg Positivity with Recurrent Falls
Single Most Likely Diagnosis
- Alcoholic Cerebellar Atrophy: Given the patient's history of ethanol (ETOH) binges and the MRI finding of mild left cerebellar atrophy, this diagnosis is highly plausible. Cerebellar atrophy can lead to ataxia, which is consistent with the patient's Romberg positivity and recurrent falls.
Other Likely Diagnoses
- Peripheral Neuropathy: This condition, which can be caused by chronic alcohol abuse, may contribute to the patient's balance issues and falls. However, it might not fully explain the cerebellar atrophy observed on MRI.
- Vestibular Dysfunction: Problems with the vestibular system can cause balance issues and falls. Given the patient's age and history of alcohol use, vestibular dysfunction could be a contributing factor, although it doesn't directly explain the cerebellar atrophy.
- Cerebellar Stroke or Infarct: Although the MRI shows atrophy rather than an acute lesion, a small, previous cerebellar stroke could have been missed or not fully evaluated, contributing to the patient's symptoms.
Do Not Miss Diagnoses
- Multiple Sclerosis (MS): Although less likely given the patient's age and presentation, MS can cause cerebellar atrophy and ataxia. Missing this diagnosis could lead to delayed treatment and significant morbidity.
- Cerebellar Tumor: A tumor in the cerebellum could cause atrophy and the patient's symptoms. This diagnosis is critical to rule out due to its potential for serious consequences if left untreated.
- Subdural Hematoma: Especially in the context of falls, a subdural hematoma could be present, even if the MRI does not show an acute lesion. This condition requires immediate medical attention.
- Wernicke's Encephalopathy: Given the patient's history of alcohol binges, Wernicke's encephalopathy is a critical diagnosis not to miss, as it is treatable and can have severe consequences if not addressed promptly.
Rare Diagnoses
- Spinocerebellar Ataxia (SCA): This is a group of genetic disorders that affect the cerebellum and could explain the patient's ataxia and cerebellar atrophy. However, the late onset and the patient's history of alcohol use make this a less likely consideration.
- Paraneoplastic Cerebellar Degeneration: This rare condition involves an immune response to a cancer elsewhere in the body that affects the cerebellum. It's unlikely but should be considered, especially if other explanations are ruled out and the patient's condition progresses.