Intro to stroke 5 - stroke mimics Flashcards
what are the 7 S’s that can mimic stroke
seizures syncope (hypotension) sugar (hyper or hypo) sepsis (+previous stroke) severe migraine space occupying lesion Si-chological
what are some other less common stroke mimics
vestibular disorders
demyelination
transient global amnesia
mononeuropathy
what causes positive symptoms
excess CNS neurone electrical discharges
give some examples of positive symptoms
visual - flashing lights, zigzags, shapes, lines, objects
somatosensory - pain, paraesthesia
motor - jerking limb movements
what causes negative symptoms
loss or reduction of CNS neurone function
give some examples of negative symptoms
loss of vision
loss of hearing
loss of sensation
loss of limb power
what are the demographics for migraine
younger age BUT can occur at any age
more common in women
what is the neurology of migraines
\+ve, spreading symptoms can be followed by -ve symptoms may evolve into different modality eg somatosensory, sequentially LOC extremely rare confusion can occur
what are the associated symptoms and timing of migraines
headaches, NV, photophobia
usually 20-30 mins
can recur over years/decades
what causes a migraine aura
cortical spreading depression
- classical spreading onset
how can an aura present and when does the headache usually start
visual disturbances
- scintillating scotolata
- geometric (espzigzag) patterns
- +ve symptoms
can include sensory, motor or speech disturbance
headache onset can be >1hr after the end of aura OR no headache
what is an acephalic migraine
aura with NV, photophobia, motor/sensory/visual disturbances BUT no headache
what are the demographics of functional/anxiety disorder
younger
more common in males
no conventional risk factors
what is the neurology in functional/anxiety disorder
isolated sensory symptoms common 60% occur suddenly or on wakening dissociative or multiple symptoms often non-dominant side inconsistency between symptoms and examination
what are the associated symptoms and timing of functional/anxiety disorder
panic
pain
physical injury
stereotypical and recurrent
what tests can indicate a functional disorder
hoovers test
abductor sign
briefly explain how hoovers test works
involuntary extension of the “normal” leg occurs when flexing the contralateral leg against resistance - if extension is felt, the paresis is most likely organic in cause, if not its most likely functional
briefly explain how the abductor sign works
the affected leg is abducted against pressure from the examiners hand - in organic paresis the contralateral leg stays in place, in non-organic paresis the contralateral leg hypperadducts
what is acute vestibular syndrome
rapid onset of vertigo, n/v, nystagmus (unidirectional), unsteady gait, and head motion intolerance lasting more than 24 hours
what are the demographics of seizures
any age
may have previous hx of epilepsy
what is the neurology of seizures
positive symptoms
LOC and amnesia common
post octal negative symptoms may persist for days
what are the associated symptoms of seizures
tongue biting incontinence muscle pain disorientation headache
what is the timing of seizures
usually progress very quickly (seconds)
last up to 5 minutes
can recur over years
usually stereotypical attacks
what are the demographics of syncope
any age, often younger
more common in women
what is the neurology of syncope
light headed (presyncope) vision may darken hearing muffled loss of awareness transient LOC with loss of posture tone and rapid recovery no focal symptoms
what is the timing of syncope
seconds to <1 minute
rapid recovery (unless patient stays upright)
can recur over years
what is transient global amnesia
temporary loss of anterograde-grade episodic memory
(usually people >50)
*NOT TIA
how long does transient global amnesia usually last
lasts several hours after which there is a filling in of old memory and a restoration of ability to lay down new ones
- a gap for the episode persist
how can you differentiate a stroke/TIA from a structural brain lesion
gradual or stuttering onset
over a longer period of time eg weeks
associated symptoms of raised ICP
