Stroke Differential Diagnosis

Question 1

Seizure/ postictal paralysis (todd paralysis)

Answer 1

transient paralysis following a sz
typically disappears quickly
post ictal phase
can be confused with TIA
sz maybe secondary to cerebrovascular event

Question 2

Syncope

Answer 2

no persistent or associated neurological symptoms

Question 3

Brain neoplasm or abscess

Answer 3

focal neurological findings
signs of infection
evident on CTB
acute neurology secondary to bleed into tumour

Question 4

extradural/ subdural hemorrhage

Answer 4

hx of trauma
alcholism
anticoagulant use
bleeding disorder
Evident on CTB

Question 5

Subarachnoid hemorrhage

Answer 5

hx of sudden onset headache

focal neurology uncommon

Question 6

hypoglycaemia

Answer 6

can cause focal neuro
bedside BSL
hx of diabetes

Question 7

Hyponatremia

Answer 7

hx of diuretic use
neoplasm
excessive free water intake

Question 8

hypertensive encephalopathy

Posterior reversible encephalopathy syndrome (PRES)

Answer 8

gradual onset
global cerebral dysfunction
headache
delirium
HTN
Cerebral edema

Question 9

Meningitis/ encephalitis

Answer 9

fever
meningism
RF: immunocompromised
LP dx

Question 10

Hyperosmotic coma

Answer 10

extremely high glucose

hx of Diabetes

Question 11

Wernicke encephalopathy

Answer 11

hx of alcoholism
malnutrition
Triad of: ataxia, ophthalmoplegia, confusion

Question 12

Labyrinthitis

Answer 12

predominantly vestibular symptoms
no other neurology
can be confused with cerebellar stroke

Question 13

drug toxicity
lithium
phenytoin
carbamezapine

Answer 13

toxidrome
elevated blood levels
phenytoin/ carbamazepine: ataxia, vertigo, nausea, abnormal reflexes

Question 14

Bell’s palsy

Answer 14

neurologic deficit isolated peripheral 7th CN palsy

Normally younger age

Question 15

Complex migraine

Answer 15

hx of similar episode
preceding aura
headache

Question 16

meniere disease

Answer 16

hx of recurrent episodes

vertigo/ tinnitus/ deafness

Question 17

Demyelinating dz: multiple sclerosis

Answer 17

gradual onset
hx of multiple episodes
multifocal anatomic distribution

Question 18

conversion disorder

Answer 18

no CN findings
non anatomic distribution of findings (eg midline sensory loss)
inconsistent hx or examination findings

Question 19

Spinal cord disorder

Answer 19

compressive myelopathy

spinal dural arteriovenous fistula

Question 20

Transient global amnesia

Answer 20

sudden amensia

no other neurology

Question 21

Viral encephalitis

Answer 21

HSV

LP

Question 22

Aortic Dissection

Answer 22

CP
Horners syndrome
HTN

Question 23

Autoimmune: vasculitis

Answer 23

Hx of

Diffuse pattern