Differential Diagnosis for New Onset Mixed Tremors with Intermittent Weakness and Confusion
- Single Most Likely Diagnosis
- Creutzfeldt-Jakob Disease (CJD): This is a neurodegenerative disorder that can present with rapidly progressive dementia, mixed tremors, myoclonus, and ataxia. The waxing and waning nature of the symptoms, along with the presence of seizures and gait unsteadiness, supports this diagnosis. The MRI findings, including lesions in the corpus callosum without enhancement, are also consistent with CJD.
- Other Likely Diagnoses
- Multiple Sclerosis (MS): Although less likely in an 80-year-old woman, MS can present with a wide range of neurological symptoms, including tremors, weakness, and confusion. The presence of lesions in the corpus callosum on MRI is consistent with MS, but the lack of enhancement and the patient's age make it less likely.
- Encephalitis: This is an inflammation of the brain that can be caused by a variety of factors, including infections and autoimmune disorders. The patient's symptoms, including confusion, seizures, and gait unsteadiness, could be consistent with encephalitis, but the normal CSF and lack of enhancement on MRI make it less likely.
- Do Not Miss Diagnoses
- CNS Lymphoma: This is a type of cancer that can present with a wide range of neurological symptoms, including confusion, weakness, and seizures. The presence of lesions in the corpus callosum on MRI could be consistent with CNS lymphoma, and it is essential to consider this diagnosis due to its potential for treatment and significant morbidity if missed.
- Vasculitis: This is an inflammation of the blood vessels that can present with a wide range of neurological symptoms, including confusion, weakness, and seizures. The patient's age and the presence of lesions in the corpus callosum on MRI could be consistent with vasculitis, and it is essential to consider this diagnosis due to its potential for treatment and significant morbidity if missed.
- Rare Diagnoses
- Hashimoto's Encephalopathy: This is a rare condition that can present with a wide range of neurological symptoms, including confusion, weakness, and seizures. The patient's symptoms and normal CSF could be consistent with Hashimoto's encephalopathy, but it is a rare condition and would require further testing to confirm.
- Whipple's Disease: This is a rare infectious disease that can present with a wide range of neurological symptoms, including confusion, weakness, and seizures. The patient's symptoms and normal CSF could be consistent with Whipple's disease, but it is a rare condition and would require further testing to confirm.