Differential Diagnosis for 65 yo F with Left Sided Upper and Lower Extremity Weakness, Numbness, and Tingling
- Single most likely diagnosis
- Ischemic Stroke: Given the patient's history of atrial fibrillation, which is a significant risk factor for thromboembolic events, an ischemic stroke is the most likely diagnosis. The sudden onset of left-sided weakness, numbness, and tingling is consistent with a stroke affecting the right hemisphere of the brain.
- Other Likely diagnoses
- Transient Ischemic Attack (TIA): Similar to ischemic stroke but transient, TIAs are temporary periods of symptoms similar to those of a stroke, lasting only a few minutes to hours. The patient's symptoms could be a TIA, especially if they resolve quickly.
- Hemorrhagic Stroke: Although less likely than ischemic stroke given the atrial fibrillation, a hemorrhagic stroke could present with similar symptoms and is an important consideration.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Spinal Cord Infarction or Compression: Conditions affecting the spinal cord, such as infarction or compression, can present with bilateral or unilateral weakness and sensory changes. These conditions require urgent intervention to prevent permanent damage.
- Multiple Sclerosis or Acute Demyelinating Neuropathy: Although less common, these conditions can present with sudden neurological deficits and must be considered, especially if the diagnosis of stroke is not clear-cut.
- Rare diagnoses
- Migraine with Aura: Some migraines can present with neurological symptoms similar to a stroke, including weakness and numbness, but these are usually accompanied by headache and visual disturbances.
- Vasculitis or Arteritis: Conditions like giant cell arteritis or primary central nervous system vasculitis can cause stroke-like symptoms but are less common and typically have other associated symptoms like headache or systemic illness.
- Neoplastic or Paraneoplastic Syndromes: Rarely, neurological symptoms can be the first presentation of a cancer, either due to direct effects of the tumor or paraneoplastic syndromes. These are important to consider if other diagnoses are ruled out.