Ischemic stroke differential diagnosis
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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 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Na+, K+, Ca2+ | CT /MRI | CSF Findings | Gold standard test | Motor Deficit | Sensory deficit | Speechdifficulty | Gait abnormality | Cranial nerves | Headache | LOC | Motor weakness | Abnormal sensations | |||
| Brain tumour[1] | ✔ | Cancer cells[2] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Cachexia | |||||
| Hemorrhagic stroke | ✔ | Xanthochromia[3] | CT scan without contrast[4][5] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Hypertension | Neck stiffness | ||
| Subdural hemorrhage | ✔ | CT scan without contrast[4][5] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | Confusion, dizziness, nausea, vomiting | |||
| Neurosyphilis[6][7] | ✔ | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[8] |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 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[9] | ✔ | ✔ | Fever, neck
rigidity | ||||||||||
| Multiple sclerosis exacerbation | ✔ | ↑ CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [10] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | |||
| Seizure | ↓ or ↑ | Clinical assesment and EEG [11] | ✔ | ✔ | ✔ | ✔ | Previous history of seizures | Confusion, apathy, irritability, | |||||||
| Hypoglycemia or hyperglycemia | ↓ or ↑ | Serum blood glucose | ✔ | ✔ | ✔ | ✔ | ✔ | History of diabetes | Palpitations, sweating, dizziness | ||||||
References
- ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
- ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ 4.0 4.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 5.0 5.1 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.
- ↑ 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.
- ↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
- ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
- ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.