Differential Diagnosis
- Single most likely diagnosis
- Acute infarct in the right ACA distribution: The MRI report specifically mentions a small right paramedian frontal lobe focus of diffusion restriction, which is compatible with an acute infarct. The location of the infarct in the right ACA distribution and its potential relation to the mass effect from the right anterior parafalcine meningioma supports this diagnosis. The acute mental status change could be a result of this infarct.
- Other Likely diagnoses
- Non-focal encephalopathy: Given the initial opinion that the presentation was consistent with non-focal encephalopathy, it remains a possible diagnosis. The underlying cause could be related to the meningioma or other factors not directly related to the acute infarct.
- Embolic stroke: Although initially ruled out, the presence of an acute infarct and a meningioma could potentially lead to an embolic event, either from the tumor itself or from associated vascular changes.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Meningioma-related complications (e.g., hemorrhage, increased intracranial pressure): The presence of a 2.9 cm meningioma with mild mass effect and underlying vasogenic edema is a significant finding. Complications from the meningioma could lead to severe and potentially life-threatening outcomes.
- Venous thrombosis: Given the location of the meningioma and the potential for mass effect, venous thrombosis is a possibility that could lead to severe consequences if missed.
- Rare diagnoses
- Tumor-related stroke (e.g., from tumor emboli): While less common, it's possible that the meningioma could directly cause a stroke through embolic mechanisms.
- Cerebral vasculitis: An inflammatory process affecting the blood vessels in the brain could potentially cause the symptoms and findings presented, although this would be a less common diagnosis.