Differential Diagnosis for Left-Sided Weakness in a 37-Week Pregnant Patient
- Single Most Likely Diagnosis
- Preeclampsia with Eclampsia: This condition is a leading cause of maternal and fetal morbidity and mortality. Preeclampsia can lead to eclampsia, which is characterized by seizures and can cause transient or permanent neurological deficits, including left-sided weakness. The patient's pregnancy status at 37 weeks increases the risk for preeclampsia.
- Other Likely Diagnoses
- Stroke: Pregnancy increases the risk of stroke due to various factors such as hypercoagulability, hypertension, and changes in blood vessels. Left-sided weakness is a common presentation of a stroke, particularly if it occurs in the right hemisphere of the brain.
- Multiple Sclerosis (MS) Exacerbation: MS is an autoimmune disease that can cause neurological symptoms, including weakness. Pregnancy can exacerbate MS symptoms in some women, leading to new or worsening neurological deficits like left-sided weakness.
- Spinal Cord Injury or Compression: Although less common, spinal cord injuries or compression due to disc herniation, spinal stenosis, or other causes can lead to left-sided weakness, especially if the lesion is located at a level that affects the left side of the body.
- Do Not Miss Diagnoses
- Venous Sinus Thrombosis: This is a rare but potentially life-threatening condition that can cause stroke-like symptoms, including left-sided weakness. Pregnancy increases the risk of venous thromboembolism, making this a critical diagnosis not to miss.
- Arteriovenous Malformation (AVM) or Aneurysm: These vascular abnormalities can rupture during pregnancy, leading to subarachnoid hemorrhage or intracerebral hemorrhage, which may present with sudden onset of left-sided weakness.
- Spinal Epidural Hematoma: Although rare, this condition can cause rapid neurological deterioration, including weakness. Prompt diagnosis and intervention are crucial to prevent permanent damage.
- Rare Diagnoses
- Neurosyphilis: This condition can cause a wide range of neurological symptoms, including weakness. Although rare, it is essential to consider in patients with risk factors for syphilis.
- Cervical Artery Dissection: This condition involves a tear in the lining of one of the arteries in the neck, which can lead to stroke or transient ischemic attack (TIA), presenting with left-sided weakness.
- Mitochondrial Myopathies: These are a group of rare genetic disorders that affect the mitochondria, leading to muscle weakness and other neurological symptoms. Pregnancy can sometimes unmask or exacerbate these conditions.