Differential Diagnosis for a 65-year-old Lady with Weakness in Right Upper and Lower Extremity and Facial Deviation
Single Most Likely Diagnosis
- Stroke (Ischemic or Hemorrhagic): The patient's symptoms of weakness in one side of the body (right upper and lower extremity) and facial deviation are classic signs of a stroke, which is a common condition in the elderly. The blood pressure of 106/84 is within a relatively normal range but does not rule out stroke.
Other Likely Diagnoses
- Transient Ischemic Attack (TIA): Similar to stroke but temporary, TIAs are often referred to as "mini-strokes" and can present with similar symptoms that resolve within 24 hours.
- Multiple Sclerosis: Although less common in new onset at 65, multiple sclerosis can present with a wide range of neurological symptoms, including weakness and facial deviation, especially if it's a relapsing form.
- Peripheral Neuropathy: While typically presenting with bilateral symptoms, in some cases, peripheral neuropathy can cause significant weakness and could potentially cause some facial deviation if cranial nerves are involved.
Do Not Miss Diagnoses
- Brain Tumor: A tumor in the brain could cause localized weakness and facial deviation, depending on its location. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
- Subdural Hematoma: Especially in the elderly, even minor trauma can lead to a subdural hematoma, which can present with focal neurological deficits like those described.
- Infections (e.g., Brain Abscess, Meningitis): Although less common, infections in the brain can cause a variety of symptoms, including focal weakness and facial deviation, and are critical to diagnose promptly due to their potential for severe consequences.
Rare Diagnoses
- Amyotrophic Lateral Sclerosis (ALS): A progressive neurological disease that affects nerve cells in the brain and spinal cord, leading to loss of muscle control. ALS could potentially present with focal weakness but is less likely given the acute onset described.
- Mitochondrial Myopathies: A group of disorders caused by dysfunctional mitochondria, which could lead to muscle weakness, but these conditions typically have a more gradual onset and are less likely to present with acute focal neurological signs.
- Vasculitis (e.g., Giant Cell Arteritis): Inflammation of the blood vessels can lead to a variety of symptoms, including neurological deficits, but would be unusual to present with such focal signs without other systemic symptoms.