Differential Diagnosis Of Acute Stroke Research Articles

Childhood Primary Angiitis of the Central Nervous System Presenting as Isolated Middle Cerebral Artery Dissection

Isolated middle cerebral artery dissection and primary angiitis of the central nervous system are two rare but serious causes of ischemic stroke in children. We report a case of a patient who presented with headache, left-sided hemiparesis, and left hemi-hypoesthesia with acute cerebral infarction in the right middle cerebral artery territory. Brain magnetic resonance imaging showed isolated right middle cerebral artery dissection with arterial wall contrast enhancement extending beyond the length of the dissection and diffuse narrowing with stenosis in the right posterior cerebral artery suggesting angiitis. After exclusion of other diagnoses the patient was treated with corticosteroids and dual antiplatelet therapy. Follow up magnetic resonance imaging performed 4 months later showed partially improved contrast enhancement in the right middle cerebral artery and persistent narrowing and focal stenosis of the right posterior cerebral artery. Although rare, primary angiitis of the central nervous system should be considered in the differential diagnosis of acute stroke in children. High-resolution vessel wall imaging magnetic resonance studies can provide important information in determining the etiology of stroke.

Hyponatremia and stroke mimic: a case report.

The differential diagnosis of acute stroke is often a challenge for the emergency care staff. In medical literature, about 30% of patients presenting in an emergency department with suspected stroke at initial assessment are actually stroke mimic. We report here a case of a 61-year-old woman who got admitted at the emergency service for an acute stroke that was actually a symptomatic hyponatremia due to a Schwartz-Bartter syndrome associated with an undiagnosed breast cancer. It is very important to quickly identify and manage patients presenting with a high probability of acute stroke even though many other pathological conditions can present with the same clinical onset. Electrolyte disturbances are one of those stroke mimic conditions that are usually reversible if properly identified and treated on time.

Giant Left Atrial Myxoma Presenting with Acute Ischemic Stroke

Primary cardiac tumors are very rare, atrial myxoma being the most common benign tumor of the heart. They may present with a great variety of incidental asymptomatic masses to severe life-threatening complications. The diagnostic evaluation of such a giant cardiac tumor which presented with acute stroke in a 36-year-old patient were presented. This article demonstrates it’s necessary to include cardiac tumors in the differential diagnosis of acute stroke. Family practitioner caring for many stroke patients should consider referring their patients to cardiologists.

Sinus and venous thrombosis — a differential diagnosis of acute stroke

Thrombosis of the cerebral veins and sinus is a rare, but important cause of stroke. The clinical picture varies. This contribution addresses the etiology, clinical picture, imaging procedures, and therapeutic options.

Acute presentation of stroke

The National Institute of Neurologic Disorders and Stroke (NINDS), a branch of the National Institutes of Health, defines stroke as sudden loss of brain function resulting from an interference with the blood supply to the brain. This definition clearly limits stroke to an acute vascular phenomena involving the brain and encompassing both hemorrhagic and ischemic events. Approximately 15% of strokes are hemorrhagic (including intracerebral hemorrhage and subarachnoid hemorrhage), and 85% are ischemic. The mortality rate for hemorrhagic stroke can be as high as 50% and is approximately 20% for ischemic strokes of all types, but ultimate outcome and function are related to the subtype of stroke. In this section, an understanding of the acute presentation and initial management of stroke is provided. Acute stroke syndromes and their diagnosis, the differential diagnosis of acute stroke, and the initial management and stabilization of acute stroke patients are reviewed.

Stroke in the developing world

Stroke is the third most common cause of death in most western populations after coronary-heart disease and cancer? It is thus the commonest life-threatening neurological disorder, and the resulting disability is the most important single cause of severe disability among western people living in their own homes) The burden of stroke on patients, their families, and society is, correctly, publicised in most developed countries. Stroke in the developing world is less well documented, and some data are not retrievable because of the language barrier or the limited dissemination of data collected. However, more than two-thirds of the world's population live in developing countries, and one of the consensus statements from the Asia-Pacific Consensus Forum on Stroke Management predicts that "In the next 30 years the burden of stroke will grow most in developing countries rather than in developed countries"? Thus stroke in developing countries ought to be examined further--in particular, the similarities and differences in stroke between developed and developing countries.

Comparability and validity of two clinical scores in the early differential diagnosis of acute stroke

To compare two available clinical scores for the differential diagnosis of cerebral ischaemia and haemorrhage in acute stroke patients. Prospective, multicentre study of acute stroke patients evaluated with computed tomography and Allen and Siriraj scores; the scores were tested for comparability (kappa statistic) and validity (sensitivity, specificity, positive and negative predictive values, diagnostic gain). The effect of a policy of using Allen and Siriraj scores to determine pathological type of stroke before computed tomography was calculated. Three hospitals in Italy, all participating in the international stroke trial, with different access facilities to computed tomography. 231 consecutive patients who were screened in the three hospitals for possible inclusion in the international stroke trial from 1 November 1991 to 31 May 1993. The prevalence of haemorrhage (diagnosed with computed tomography) was 14.7% (95% confidence interval 10.1% to 19.3%). Allen scores were "uncertain" in 44 cases and Siriraj scores in 38 cases; in the 164 cases with both the scores in the range of "certainty" kappa was 0.72. Sensitivity, specificity, positive and negative predictive values, and diagnostic gain for haemorrhage were 0.38, 0.98, 0.71, 0.91, and 0.58 for Allen scores and 0.61, 0.94, 0.63, 0.93, and 0.48 for Siriraj scores; positive predictive values for infarction were 91% for Allen scores and 93% for Siriraj scores. According to these data, of 1000 patients with acute stroke, 680 would be correctly and 70 wrongly diagnosed as "ischaemic" with the Allen score; the figures would be 671 and 48 with Siriraj score. When computed tomography is not immediately available and the clinician wishes to start antithrombotic treatment (or randomise patients in a clinical trial), the Siriraj score (and possibly the Allen score) can be useful to identify patients at low risk of intracerebral haemorrhage.

Differential Diagnosis of Acute Stroke: A Review

Differential Diagnosis of Acute Stroke: A Review