CWH C1126710

 a

From the clinical note and MRI comment, the key features are:

• Acute onset (16:30)

• Left-sided weakness and facial asymmetry/drooling

• Nausea/vomiting

• MRI suggesting right MCA territory process

• Minor recent head/eye trauma

• Concern raised for infarct vs cerebritis

Top 3 Differential Diagnoses

1. Acute arterial ischemic stroke (Right MCA territory)

   • Fits the sudden onset focal deficit (left arm weakness, facial droop).

   • Pediatric causes may include arterial dissection, vasculitis, cardioembolism, or prothrombotic states.

   • The recent minor trauma could suggest carotid or intracranial arterial dissection.

2. Cerebritis / early brain abscess (infective focal encephalitis)

   • MRI differential already raises this.

   • Nausea, vomiting, focal neurology, and treatment started with ceftriaxone + acyclovir + azithromycin, suggesting concern for bacterial or viral CNS infection.

3. Intracranial arterial dissection with secondary stroke (post-traumatic)

   • Minor trauma (bumped head/eye on car door) could precede carotid or MCA dissection, leading to ischemic stroke in children.

   • MRA was appropriately requested.

✅ Summary:

1. Right MCA ischemic stroke

2. Cerebritis / focal encephalitis

3. Traumatic arterial dissection causing pediatric stroke

If you want, I can also give:

• Key investigations to differentiate them quickly, or

• Common causes of stroke in children for exams (very testable).