Stroke (Apoplexy): Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90).

Cardiovascular (I00-I99).

  • Dissection (splitting of the wall layers) of the carotid artery (common cause of stroke in younger people: proportion of 10-25%).
  • Intracerebral hemorrhage (ICB; cerebral hemorrhage).
  • Sinus vein thrombosis (SVT) – occlusion of a cerebral sinus (large venous blood vessels of the brain arising from duraduplications) by a thrombus (blood clot); symptomatology: headache, congestive papules, and epileptic seizures.
  • Subarachnoid hemorrhage (SAB; hemorrhage between the spinal meninges and the soft meninges; incidence: 3-5%); symptomatology: proceed according to “Ottawa rule for subarachnoid hemorrhage”:
    • Age ≥ 40 years
    • Meningismus (symptom of painful neck stiffness in irritation and disease of the meninges).
    • Syncope (brief loss of consciousness) or impaired consciousness (somnolence, sopor and coma).
    • Onset of cephalgia (headache) during physical activity.
    • Thunderclap headache (about 50% of cases).
    • Restricted mobility of the cervical spine (Cervical spine).
  • Subdural hematoma (SDH) – Hematoma (bruise) under the hard meninges between the dura mater (hard meninges) and arachnoid (spider tissue membrane); high-risk group:
    • Acute subdural hematoma (aSDH)Symptoms: Disturbances of consciousness up to unconsciousness
    • Chronic subdural hematoma (cSDH)symptoms: uncharacteristic complaints such as a feeling of pressure in the head, cephalgia (headache), vertigo (dizziness), restriction or loss of orientation and ability to concentrate

Infectious and parasitic diseases (A00-B99).

  • Infections, unspecified [Stroke mimics]
  • Sepsis (blood poisoning) [Stroke mimics]

Neoplasms – tumor diseases (C00-D48).

  • Brain metastases
  • Brain tumors, unspecified

Psyche – nervous system (F00-F99; G00-G99)

  • Encephalitis (inflammation of the brain).
  • Epileptic seizure Note: Epileptic seizures occur as the first symptom in 2-4% of cerebral ischemias and cerebral hemorrhages. [is among the common “stroke mimics”/differential diagnoses that must be distinguished from stroke].
  • Meningitis (meningitis).
  • Multiple sclerosis (MS) – inflammatory/demyelinating and degenerative disease of the central nervous system that can cause spasticity and paresis (paralysis).
  • Myasthenic syndromes – disorders of neuromuscular signal transmission whose cause is not an autoimmune process, as in myasthenia gravis, but a genetic defect at the synapse (junction from nerve to muscle) [stroke mimics].
  • Migraine with aura (MA) [is one of the common “stroke mimics”/differential diagnoses that must be differentiated from stroke]
  • Migraine without aura
  • Psychogenic or dissociative states [is one of the common “stroke mimics”/differential diagnoses that must be distinguished from stroke].
  • Psychogenic hemiparesis – hemiplegia due to mental disorders.
  • Transient ischemic attack – sudden onset of circulatory disturbance in the brain leading to neurological disturbances that remit within 24 hours

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Systemic inflammatory response syndrome (SIRS) – generalized response of the body to an external agent. Causes may include toxins from microorganisms (e.g., bacteria, fungi, viruses, parasites), severe injury, or burns.
  • Vertigo – dizziness due to affections of the labyrinth (benign paroxysmal positional vertigo (BPLS), neuritis vestibularis) [Stroke mimics].

Injuries, poisonings, and other sequelae of external causes (S00-T98).

  • Subdural hematoma (SDH)