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Stroke, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the differential diagnosis for stroke:
Syncope, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the neurologic differential diagnosis for syncope:
{|
{|
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
Line 22: Line 22:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard test
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain tumor]]<ref name="pmid105826682">{{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><ref name="pmid213713272">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural hematoma|Subdural hemorrhage]]<ref name="pmid216947552">{{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 name="pmid218073452">{{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>
| align="left" style="background:#F5F5F5;" |
*[[Weight loss]]
*[[Fatigue]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Cancer cells
| align="center" style="background:#F5F5F5;" |MRI
| align="left" style="background:#F5F5F5;" |
*[[Cachexia]]
*Gradual progression of symptoms
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]<ref name="pmid216947552">{{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 name="pmid218073452">{{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>
| align="left" style="background:#F5F5F5;" |
*[[Hypertension]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |CT scan without contrast
| align="left" style="background:#F5F5F5;" |
*[[Neck stiffness]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural hematoma|Subdural hemorrhage]]<ref name="pmid216947552" /><ref name="pmid218073452" /><ref name="pmid11986282">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Trauma]]
*[[Trauma]]
*Fall
*Fall
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |[[Xanthochromia]]
| align="center" style="background:#F5F5F5;" |[[Xanthochromia]]
| align="center" style="background:#F5F5F5;" |CT scan without contrast
| align="center" style="background:#F5F5F5;" |CT scan without contrast
Line 81: Line 43:
*[[Nausea and vomiting]]
*[[Nausea and vomiting]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid224828242">{{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="pmid243654302">{{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><ref name="pmid224216972">{{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: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Sexually transmitted disease]]
*[[Sexually transmitted disease]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ [[Leukocytes]] and [[protein]]
| align="center" style="background:#F5F5F5;" |↑ [[Leukocytes]] and [[protein]]
| align="center" style="background:#F5F5F5;" |Specific: CSF [[VDRL]]
| align="center" style="background:#F5F5F5;" |Specific: CSF [[VDRL]]
Line 102: Line 64:
*[[Depression]]
*[[Depression]]
*Abnormal [[gait]]
*Abnormal [[gait]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
| align="left" style="background:#F5F5F5;" |
*Family history of [[migraine]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical assesment
| align="left" style="background:#F5F5F5;" |
*Presence of [[aura]]
*[[Nausea and vomiting]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
Line 161: Line 104:
*[[Ophthalmoplegia]]
*[[Ophthalmoplegia]]
*[[Confusion]]
*[[Confusion]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
| align="left" style="background:#F5F5F5;" |
*History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ leukocytes, ↓ glucose and ↑ protien
| align="center" style="background:#F5F5F5;" |MRI is more sensitive and specific
| align="left" style="background:#F5F5F5;" |
*High grade [[fever]]
*[[fatigue]]
*Nausea and vomiting
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
| align="left" style="background:#F5F5F5;" |Medication history of
| align="left" style="background:#F5F5F5;" |Medication history of
*[[Lithium]]
*[[Lithium]]
*[[Sedatives]]
*[[Sedatives]]
Line 189: Line 113:
*[[Carbamazepine]]
*[[Carbamazepine]]
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Drug screen test
| align="center" style="background:#F5F5F5;" |Drug screen test
| align="center" style="background:#F5F5F5;" |–
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
*History of [[emotional stress]]
* Confusion
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Diagnosis of exclusion
| align="left" style="background:#F5F5F5;" |
*[[Tremor]]
*[[Blindness]]
*Difficulty [[swallowing]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
Line 244: Line 149:
*[[Hypoglycemia]]
*[[Hypoglycemia]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]]<ref name="pmid193982862">{{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>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*History of [[fever]] and [[malaise]]
*History of [[fever]] and [[malaise]]
Line 262: Line 167:
*[[Fever]]
*[[Fever]]
*Neck rigidity
*Neck rigidity
*[[Confusion]]
|-
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid82741112">{{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>
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
| align="left" style="background:#F5F5F5;" |
*History of relapses and remissions
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ CSF IgG levels, (monoclonal bands)
| align="center" style="background:#F5F5F5;" |Clinical assesment and [[MRI]]
| align="left" style="background:#F5F5F5;" |
*Blurry [[vision]]
*[[Urinary incontinence]]
*[[Fatigue]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]<ref name="pmid113850432">{{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>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*Previous history of [[seizures]]
*Previous history of [[seizures]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |Mass lesion
| align="center" style="background:#F5F5F5;" |Mass lesion

Revision as of 17:32, 26 April 2020

Syncope, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the neurologic differential diagnosis for syncope:

Diseases History Symptoms Physical Examination Diagnostic tests Other Findings
Headache ↓ LOC Motor weakness Abnormal sensory Motor Deficit Sensory deficit Speech difficulty Gait abnormality Cranial nerves CT/MRI CSF Gold standard test
Subdural hemorrhage[1][2] + + + + + + + Xanthochromia CT scan without contrast
Neurosyphilis + + + + + + + Leukocytes and protein Specific: CSF VDRL

Sensitive: CSF FTA-Ab

Hypertensive encephalopathy + + + + + NA Clinical assesment
Wernicke’s encephalopathy
  • History of alcohal abuse
+ + + + + NA Clinical assesment and lab findings
Drug toxicity Medication history of + + + + + NA Drug screen test
  • Confusion
Metabolic disturbances (electrolyte imbalance, hypoglycemia) + + + + + + Hypoglycemia, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia Depends on the cause
Meningitis or encephalitis + + + ↑ Leukocytes, ↑ protein, ↓ glucose CSF analysis
Seizure + + + + + Mass lesion Clinical assesment and EEG
Common Causes of Sick sinus syndrome
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Images

Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia


Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia


Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia


Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia


Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia


Contrast enhanced CT: Aortic intramural hematoma, Courtesy of radiopaedia




Disease Name Age of Onset Gender Preponderance Signs/Symptoms Imaging Feature(s) Macroscopic Feature(s) Microscopic Feature(s) Laboratory Findings(s) Other Feature(s) ECG view
  1. Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
  2. DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.