Hemorrhagic stroke differential diagnosis: Difference between revisions

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*Presents with gradual onset head and neck pain with a local manifestations (such as [[Horner syndrome]], pulsatile [[tinnitus]], bruit, or cranial [[neuropathies]])
*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)  
*Neuroimagings are usually preferred  (brain MRI with MRA and cranial CT with CTA)  
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Reversible cerebral vasoconstriction syndrome'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*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
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[intracranial hypotension|Spontaneous intracranial hypotension]]'''<ref name="pmid1549206">{{cite journal| author=Rando TA, Fishman RA| title=Spontaneous intracranial hypotension: report of two cases and review of the literature. | journal=Neurology | year= 1992 | volume= 42 | issue= 3 Pt 1 | pages= 481-7 | pmid=1549206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1549206  }} </ref><ref name="pmid11270540">{{cite journal| author=Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK| title=Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. | journal=Neurosurgery | year= 2001 | volume= 48 | issue= 3 | pages= 513-6; discussion 516-7 | pmid=11270540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11270540  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[intracranial hypotension|Spontaneous intracranial hypotension]]'''<ref name="pmid1549206">{{cite journal| author=Rando TA, Fishman RA| title=Spontaneous intracranial hypotension: report of two cases and review of the literature. | journal=Neurology | year= 1992 | volume= 42 | issue= 3 Pt 1 | pages= 481-7 | pmid=1549206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1549206  }} </ref><ref name="pmid11270540">{{cite journal| author=Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK| title=Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. | journal=Neurosurgery | year= 2001 | volume= 48 | issue= 3 | pages= 513-6; discussion 516-7 | pmid=11270540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11270540  }} </ref>

Revision as of 18:14, 3 November 2016

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

Overview

Differential diagnosis

[1][2]

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[3]
  • 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[4]
  • 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[5][6]
  • 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[7]
  • 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[8][9]
  • 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[10][11]
  • 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

References

  1. ↑ Linn FH, Rinkel GJ, Algra A, van Gijn J (1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". J Neurol Neurosurg Psychiatry. 65 (5): 791–3. PMC 2170334. PMID 9810961.
  2. ↑ Markus HS (1991). "A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 54 (12): 1117–8. PMC 1014694. PMID 1783930.
  3. ↑ Polmear A (2003). "Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review". Cephalalgia. 23 (10): 935–41. PMID 14984225.
  4. ↑ Dodick DW, Wijdicks EF (1998). "Pituitary apoplexy presenting as a thunderclap headache". Neurology. 50 (5): 1510–1. PMID 9596029.
  5. ↑ de Bruijn SF, Stam J, Kappelle LJ (1996). "Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group". Lancet. 348 (9042): 1623–5. PMID 8961993.
  6. ↑ Bousser MG, Chiras J, Bories J, Castaigne P (1985). "Cerebral venous thrombosis--a review of 38 cases". Stroke. 16 (2): 199–213. PMID 3975957.
  7. ↑ KELLY R (1951). "Colloid cysts of the third ventricle; analysis of twenty-nine cases". Brain. 74 (1): 23–65. PMID 14830663.
  8. ↑ Mitsias P, Ramadan NM (1992). "Headache in ischemic cerebrovascular disease. Part I: Clinical features". Cephalalgia. 12 (5): 269–74. PMID 1423556.
  9. ↑ Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL; et al. (2003). "Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study". Neurology. 61 (10): 1347–51. PMID 14638953.
  10. ↑ Rando TA, Fishman RA (1992). "Spontaneous intracranial hypotension: report of two cases and review of the literature". Neurology. 42 (3 Pt 1): 481–7. PMID 1549206.
  11. ↑ Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK (2001). "Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage". Neurosurgery. 48 (3): 513–6, discussion 516-7. PMID 11270540.


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