Ischemic stroke differential diagnosis: Difference between revisions

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Revision as of 02:16, 9 November 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

Differential Diagnosis

Diseases	Diagnostic tests					Physical Examination				Symptoms				Past medical history	Other Findings
Diseases	CBC	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Motor Deficit	Sensory deficit	Speech or gait?	Cranial nerves	Headache	LOC	Motor weakness	Abnormal sensations		Other Findings
Brain tumour^[1]	N		+		MRI	+	+		+	+					Cahexia
Hemorrhagic stroke	N		+		CT scan without contrast</ref></ref>	+	+		+	+	+	+		Hypertension+
Subdural hemorrhage	N		+		CT scan without contrast^[2]^[3]	+	+		+	+	+	+		Trauma/fall
Neurosyphilis^[4]^[5]	lymphocytosis		+		CSF VDRL-specifc CSF FTA-Ab -sensitive^[6]	+	+			+		+	+	STIs
Complex or atypical migraine	N				Clinical assesment					+			+	Family history of migraine
Conversion disorder	N	↓			Diagnosis of exclusion??	+	+			+	+	+	+
Electrolyte disturbance	N
Intracranial neoplasm
Meningitis or encephalitis	TLC				CSF analysis</ref>				+	+					Fever, Neck rigidity
Multiple sclerosis exacerbation			+		Clinical assesment and MRI </ref>	+	+					+	+	History of relapses and remissions
Seizure					Clinical assesment and EEG ^[7]	+				+	+		+	History of similar episodes in the past
Hypoglycemia or hyperglycemia					HbA1c					+	+		+	History of diabetes	Palpitations, sweating

References

↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
↑
↑
↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

Template:WikiDoc Sources

[pmid10582668-1] Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.

[:0-2] ↑

[:1-3] ↑

[pmid22482824-4] Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.

[pmid24365430-5] Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.

[pmid22421697-6] Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.

[pmid11385043-7] Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.

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@@ Line 16: / Line 16: @@
 |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
 !CBC
-!BMP
+!Na+, K+, Ca2+
 !CT /MRI
 !CSF Findings
@@ Line 22: / Line 22: @@
 !Motor Deficit
 !Sensory deficit
-!Reflexes
+!Speech or gait?
 !Cranial
 nerves
@@ Line 32: / Line 32: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }} </ref>
+|style="background: #F5F5F5; padding: 5px;" |N
 |style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |MRI
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |↓
 |style="background: #F5F5F5; padding: 5px;" |      <nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 49: / Line 49: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhagic stroke
+|style="background: #F5F5F5; padding: 5px;" |N
 |style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name=":0"><ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref></ref><ref name=":1"><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref></ref>
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 66: / Line 66: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
+|style="background: #F5F5F5; padding: 5px;" |N
 |style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name=":0" /><ref name=":1" />
-|style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 83: / Line 83: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Neurosyphilis<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |lymphocytosis
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |↓
+|style="background: #F5F5F5; padding: 5px;" |CSF VDRL-specifc
+CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 100: / Line 101: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical migraine
-|style="background: #F5F5F5; padding: 5px;" |'''↑'''
+|style="background: #F5F5F5; padding: 5px;" |N
-|style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
@@ Line 112: / Line 113: @@
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Family history of migraine
 |style="background: #F5F5F5; padding: 5px;" |
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |N
 |style="background: #F5F5F5; padding: 5px;" |↓
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |↓
+|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion??
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 129: / Line 130: @@
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |N
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
@@ Line 168: / Line 169: @@
 |-
 |style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
+|style="background: #F5F5F5; padding: 5px;" |TLC
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |CSF analysis<ref><ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref></ref>
-|style="background: #F5F5F5; padding: 5px;" |↓
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
@@ Line 189: / Line 190: @@
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment and MRI <ref><ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref></ref>
-|style="background: #F5F5F5; padding: 5px;" |↓
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
@@ Line 200: / Line 201: @@
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
 |style="background: #F5F5F5; padding: 5px;" |
 |-
@@ Line 208: / Line 209: @@
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |↓
+|style="background: #F5F5F5; padding: 5px;" |Clinical assesment and EEG <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
@@ Line 216: / Line 217: @@
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of similar episodes in the past
 |style="background: #F5F5F5; padding: 5px;" |
 |-
@@ Line 225: / Line 226: @@
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |HbA1c
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |
@@ Line 234: / Line 235: @@
 |style="background: #F5F5F5; padding: 5px;" |
 |style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
-|style="background: #F5F5F5; padding: 5px;" |
+|style="background: #F5F5F5; padding: 5px;" |History of diabetes
 |style="background: #F5F5F5; padding: 5px;" |Palpitations, sweating
 |}

Ischemic stroke differential diagnosis: Difference between revisions

Revision as of 02:16, 9 November 2016

Overview

Differential Diagnosis

References

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