Differential Diagnosis for Evolving Right Middle Cerebral (MC) Stroke
- Single most likely diagnosis
- Ischemic stroke due to atherosclerosis or cardioembolism: This is the most common cause of stroke and typically presents with sudden onset of focal neurological deficits, which can evolve over time.
- Other Likely diagnoses
- Lacunar stroke: Small vessel disease can cause strokes that may evolve over hours, often presenting with pure motor or sensory symptoms.
- Hemorrhagic transformation of an ischemic stroke: Initially, an ischemic stroke can evolve into a hemorrhagic stroke, which would significantly change management.
- Venous sinus thrombosis: Though less common, this can cause stroke-like symptoms and may evolve over time, often associated with headache and seizures.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Subarachnoid hemorrhage (SAH): Although SAH typically presents with sudden, severe headache and may not always cause focal neurological deficits, it can sometimes mimic an evolving stroke and is critical to diagnose early due to its high mortality.
- Cerebral vasculitis: Inflammatory diseases affecting the blood vessels of the brain can cause strokes and may evolve over time, requiring early diagnosis for appropriate treatment.
- Reversible cerebral vasoconstriction syndrome (RCVS): This condition can cause strokes and is often associated with severe headaches, requiring specific management to prevent further complications.
- Rare diagnoses
- Migraine with aura: In rare cases, a migraine aura can mimic the symptoms of a stroke, including evolving neurological deficits, but typically has a more gradual onset and is accompanied by headache.
- Cerebral amyloid angiopathy (CAA): This condition can cause lobar hemorrhages and, in rare instances, may present with evolving symptoms that could be mistaken for an ischemic stroke.
- Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS): A rare genetic disorder that can cause stroke-like episodes, often with a more gradual onset and associated with other systemic symptoms.