Differential Diagnosis for Monoparesis Left Upper Limb with History of CABG 10 Years Ago
Single Most Likely Diagnosis
- Stroke (Ischemic or Hemorrhagic): Given the history of CABG, which indicates atherosclerotic heart disease, and the presentation of monoparesis, a stroke is the most likely diagnosis. The history of cardiac surgery increases the risk of cerebrovascular events due to potential embolic sources or accelerated atherosclerosis.
Other Likely Diagnoses
- Peripheral Nerve Injury: Trauma or compression of the nerves supplying the left upper limb could result in monoparesis. This could be due to various reasons such as a fall, compression by a tumor, or entrapment neuropathy.
- Cervical Spondylosis with Radiculopathy: Degenerative changes in the cervical spine can compress nerve roots, leading to weakness in specific limb distributions. Given the age of someone 10 years post-CABG, this is a plausible consideration.
- Brachial Plexus Injury: Similar to peripheral nerve injury, trauma or other insults to the brachial plexus can cause monoparesis of the left upper limb.
Do Not Miss Diagnoses
- Acute Spinal Cord Infarction: Although less common, spinal cord infarction can present with acute onset of limb weakness. Given the potential for devastating outcomes if missed, it's crucial to consider this diagnosis.
- Multiple Sclerosis: An initial presentation or relapse of multiple sclerosis could manifest as monoparesis. Early diagnosis and treatment are critical to prevent long-term disability.
- Spinal Epidural Hematoma or Abscess: These conditions require urgent intervention to prevent permanent neurological damage. They can present with focal neurological deficits, including monoparesis.
Rare Diagnoses
- Motor Neuron Disease (e.g., Amyotrophic Lateral Sclerosis): While rare, these diseases can present with focal weakness that progresses over time. Early diagnosis is challenging but crucial for management.
- Neoplastic Lesions (e.g., Metastatic Disease to the Spine or Brain): Tumors can cause focal neurological deficits by compressing or infiltrating neural structures. Given the history of CABG, which may indicate a higher risk of other systemic diseases, considering neoplastic processes is important.
- Inflammatory or Infectious Myopathies: Conditions like polymyositis or dermatomyositis can cause limb weakness, although they typically present with more systemic symptoms and proximal muscle involvement.