Hemorrhagic stroke differential diagnosis

Hemorrhagic stroke Microchapters
Main Stroke Page
Ischemic Stroke Page
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Emergency Diagnosis and Assessment
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
CT
MRI
Other Imaging Findings
Treatment
Early Assessment
NIH Stroke Scale
Management
Surgery
Rehabilitation
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) Management of ICH
AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) Management of aSAH
AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) Primary Prevention of Stroke
AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (2014) Overview Sex-Specific Risk Factors Pregnancy and Complications Cerebral Venous Thrombosis Oral Contraceptives Menopause and Postmenopausal Hormonal Therapy Risk Factors Commoner in Women Migraine with Aura Obesity, Metabolic Syndrome, and Lifestyle Factors Atrial Fibrillation Prevention
Case Studies
Case #1
Hemorrhagic stroke differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hemorrhagic stroke differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hemorrhagic stroke differential diagnosis
CDC on Hemorrhagic stroke differential diagnosis
Hemorrhagic stroke differential diagnosis in the news
Blogs on Hemorrhagic stroke differential diagnosis
Directions to Hospitals Treating Stroke
Risk calculators and risk factors for Hemorrhagic stroke differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differential diagnosis

Disease	Findings
Ischemic stroke	Occurs when a clot or a mass clogs a blood vessel and cutting off the blood flow to the brain Present as a Thrombotic stroke (thrombus develops at the clogged part of the vessel) Embolic strokes (blood clot that forms at another locations usually the heart and large arteries of the upper chest and neck, and travels to the brain) Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
transient ischemic attack (TIA)	Caused by a temporary clot which often called a “mini stroke” Occurs rapidly and presents as a sudden onset of a focal neurologic symptom/sign lasting less than 24 hours Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
Acute hypertensive crisis/Malignant hypertension	Presents as significantly elevated blood pressure (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) with or wihout acute end-organ injury Urgent evaluation with MRI and CT of the brain, serum creatinine, urinalysis, cardiac (EKG, chest x ray, and cardiac enzymes) and metabolic evaluation is often necessary
Sentinel headache	Caused by small aneurysmal leaks into the subarachnoid space Presents as a episode of headache similar to that accompanying subarachnoid hemorrhage (days to weeks prior to aneurysm rupture) and focal neurologic symptoms and signs are usually absent
Sinusitis	Presents with acute and subacute headaches and facial pain
Hypoglycemia
Pituitary apoplexy	Caused by pituitary gland infarct or hemorrhage secondary to pitutiery adenoma Presents with acute headache, change in mental status, ophthalmoplegia, and decreased visual acuity Brain CT and MRI are the preferred imaging techniques
Cerebral venous thrombosis	Presents with isolated gradual onset headache or in combination with papilledema, seizures, bilateral focal deficits, and change in mental status Brain MRI with venography should be considered
Colloid cyst of the third ventricle	Caused by an acute obstructive hydrocephalus secondary to sudden obstruction in cerebrospinal fluid flow by the cyst Presents with an acute onset fronto-parietal or fronto-occipital headache which relieved by taking the supine position and may be associated with nausea, vomiting, mental status changes, seizures, coma Head CT or MRI of the brain are usually diagnostic
Cervical artery dissection	It usulay occurs spontaneously or after head and neck injury Presents with gradual onset head and neck pain with a local manifestations (such as Horner syndrome, pulsatile tinnitus, bruit, or cranial neuropathies) Neuroimagings are usually preferred (brain MRI with MRA and cranial CT with CTA)
Reversible cerebral vasoconstriction syndrome	Occurs spontaneously and trigerred by sexual activity, exertion, emotion, and constriction of the cerebral arteries Presents with acute severe headache with or without focal deficits or seizures that resolves spontaneously within 12 weeks
Spontaneous intracranial hypotension	Presents with orthostatic headaches, nausea, vomiting, dizziness, diplopia, interscapular pain Caused by cerebrospinal fluid (CSF) leakage from spinal meningeal defects or dural tears Brain MRI is the preferred imaging techniques

Organ System	Disease	Symptoms	Signs	Laboratory findings	Diagnostic modality	Management
Cardiac	HFpEF	Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema	Elevated JVP, fine crackles, edema	Increased BNP	Echocardiography (normal EF)	Control of volume overload and hypertension, treatment of underlying condition (obesity, AF, coronary artery disease, anemia)
	HFrEF	Exertional dyspnea, reduced exercise tolerance, orthopnea, paroxysmal nocturnal dyspnea, edema	Elevated JVP, fine crackles, edema	Increased BNP	Echocardiography (reduced EF)	Diuretics, ACE inhibitors, ARBs, beta blockers, nitrates
	Pericardial disease	Exercise intolerance, dyspnea, fatigue	Elevated JVP, pericardial knock, kussmaul's sign, pulsus paradoxus	-	Echocardiography, ECG	Diuretics, pericardiectomy
	Hypertrophic cardiomyopathy	Dyspnea, chest pain, palpitation, lightheadedness	Systolic murmur	-	Echocardiography, ECG	Beta blockers, verapamil
	Valvular disease (MR, TR)	Edema, fatigue, exercise intolerance, dyspnea, lightheadedness	Cardiac murmur	-	Echocardiography, ECG	Valve repair or replacement, diuretics, beta blockers
	Arrhythmia	Palpitation, lightheadedness, chest tightness	Tachycardia, abnormal pulse	-	Echocardiography, ECG, holter monitoring	Pharmacological cardioversion (anti arrhythmics), electrical cardioversion, ablation
Pulmonary	Chronic airway disease	Cough, dyspnea, chest pain, exercise intolerance	Tachypnea, respiratory distress, cyanosis, edema, rhonchi and crackles	Hypoxemia, hypercapnea, polycythemia,	PFT, chest imaging	Bronchodilators, corticosteroids, anticholinergics
	Interstitial lung diseaee	Exercise intolerance, cough	Crackles, clubbing, cyanosis	Hypoxemia	PFT, Chest imaging, lung biopsy	Corticosteroids, bronchodilators
	Pulmonary hypertension	Dyspnea, fatigue, chest pain, syncope, palpitation	Edema, clubbing, elevated JVP, TR murmur	Elevated BNP, elevated d-dimer	Echocardiography, cardiac cathaterization	Diuretics, calcium channel blockers, endothelin receptor antagonist, phosphodiesterase 5 inhibitor
	Sleep apnea	Snoring, somnolence, headache, fatigue, irritability	tachypnea, hypertension, tachycardia	Hypoxemia, polycythemia	Polysomnography	Weight reduction, CPAP
High output status	Anemia	Palpitation, lightheadedness, fatigue	Cheilosis, delayed capillary refill	Decreased Hb and HCT	CBC, Iron study, bone marrow aspiration and biopsy	Iron replacement, nutritional support
	Thyrotoxicosis	Palpitation, sweating, weight loss	Proptosis, tachycardia	Decreased TSH, increased T3,T4	Thyroid function test	Thyrostatics, beta blockers, ablation
Others	Liver disease	Fatigue, edema, jaundice	Ascites, palmar erythema, gynecomastia	Increased AST and ALT, decreased albumin, increased Br	Liver function test, Liver biopsy	Diuretics, treatment of underlying disease
	Chronic kidney disease	Fatigue, anorexia, nausea, edema, decreased exercise tolerance	Edema, hypertension, crackles	Increased BUN and Cr	BUN, Cr	Control of blood pressure, anemia, dialysis, kidney transplant

Diseases	Diagnostic tests				Physical Examination					Symptoms				Past medical history	Other Findings
	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Headache	LOC	Motor weakness	Abnormal sensations
Brain tumour		✔	Cancer cells	MRI	✔	✔	✔	✔	✔	✔					Cachexia
Hemorrhagic stroke		✔	Xanthochromia	CT scan without contrast	✔	✔	✔	✔	✔	✔	✔	✔		Hypertension	Neck stiffness
Subdural hemorrhage		✔		CT scan without contrast	✔	✔	✔	✔	✔	✔	✔	✔		Trauma/fall	Confusion, dizziness, nausea, vomiting
Neurosyphilis		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive	✔	✔	✔	✔		✔		✔	✔	STIs	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine				Clinical assesment			✔			✔			✔	Family history of migraine	Presence of aura, nausea, vomiting
Conversion disorder				Diagnosis of exclusion	✔	✔	✔	✔		✔	✔	✔	✔		Tremors, blindness, difficulty swallowing
Electrolyte disturbance	↓ or ↑			Depends on the cause											Confusion, seizures
Meningitis or encephalitis			↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis					✔	✔					Fever, neck rigidity
Multiple sclerosis exacerbation		✔	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	✔	History of relapses and remissions	Blurry vision, urinary incontinence, fatigue
Seizure	↓ or ↑			Clinical assesment and EEG	✔					✔	✔		✔	Previous history of seizures	Confusion, apathy, irritability,
Hypoglycemia or hyperglycemia	↓ or ↑			Serum blood glucose HbA1c			✔	✔		✔	✔		✔	History of diabetes	Palpitations, sweating, dizziness

References

Template:WS Template:WH