Differential Diagnosis
- Stroke Mimics:Hypoglycemia. Migraine with aura. Seizure with Todd's paralysis. Brain tumor. Multiple sclerosis
Diagnosis of Acute Cerebrovascular Disorders (Stroke)
Definition
Acute disorders of cerebral circulation include:
Ischemic stroke
- Intracerebral hemorrhage (ICH)
- Subarachnoid hemorrhage (SAH)
- Transient ischemic attack (TIA)
Clinical Diagnosis
- Key Features Sudden onset. Focal neurological deficit. Symptoms correspond to vascular territory
- Common Findings: Hemiparesis/hemiplegia. Facial palsy. Aphasia. Sensory deficits. Visual field defects. Ataxia. Altered consciousness
Diagnostic Methods
A. Brain CT (First-line Investigation)
- Purpose: Distinguishes ischemic from hemorrhagic stroke. Detects intracerebral bleeding
B. MRI
- More sensitive for: Early ischemia. Brainstem infarcts. Small infarctions
C. Vascular Studies: CT angiography (CTA). MR angiography (MRA). Digital subtraction angiography (DSA)
- Used to identify: Arterial occlusion. Stenosis. Aneurysms
D. Ultrasound: Carotid Doppler. Transcranial Doppler
E. Cardiac Evaluation: ECG. Echocardiography
- Important for detecting: Atrial fibrillation. Cardioembolic sources
F. Laboratory Tests: CBC. Blood glucose. Electrolytes. Coagulation profile. Lipid profile
Differential Diagnosis of Stroke
A. Hypoglycemia
- May mimic stroke: Confusion. Hemiparesis. Speech disturbance
- Distinguished by: Low blood glucose
B. Seizure with Todd's Paralysis: Temporary postictal weakness. History of seizure
C. Migraine with Aura: Visual symptoms. Gradual progression. Usually younger patients
D. Brain Tumor: Progressive symptoms. Not sudden onset
E. Multiple Sclerosis: Young adults. Relapsing neurological deficits
F. Encephalitis: Fever. Altered mental status. CSF inflammatory changes