Differential Diagnosis for Stroke
Single Most Likely Diagnosis
- Ischemic stroke: This is the most common type of stroke, accounting for approximately 87% of all strokes. It occurs when a blood vessel in the brain is blocked, reducing blood flow and oxygen to the brain. The high prevalence and typical presentation of sudden onset of focal neurological deficits make it the single most likely diagnosis.
Other Likely Diagnoses
- Hemorrhagic stroke: Accounting for about 13% of strokes, hemorrhagic strokes occur when a blood vessel in the brain ruptures, causing bleeding in or around the brain. Symptoms can be similar to ischemic stroke but may also include headache, vomiting, and decreased consciousness.
- Transient ischemic attack (TIA): Often referred to as a "mini-stroke," TIAs are temporary periods of symptoms similar to those of a stroke. They don't cause permanent damage but are a warning sign of a future stroke, making prompt evaluation and treatment crucial.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less common, this condition involves bleeding into the space surrounding the brain and can present with sudden, severe headache, often described as "the worst headache" ever experienced. It requires immediate medical attention.
- Venous sinus thrombosis: A rare cause of stroke, it involves a blood clot in the venous sinuses of the brain. It can present with headache, seizures, and focal neurological deficits, and is particularly important to consider in young women and those with hypercoagulable states.
- Reversible cerebral vasoconstriction syndrome (RCVS): Characterized by sudden, severe headaches and sometimes neurological deficits, RCVS is due to temporary narrowing of blood vessels in the brain. It can mimic stroke but requires different management.
Rare Diagnoses
- Cerebral vasculitis: Inflammation of the blood vessels in the brain, which can cause stroke-like symptoms. It's rare and often associated with systemic diseases or infections.
- Moyamoya disease: A rare condition caused by narrowing or blockage of the internal carotid artery and its branches, leading to reduced blood flow to the brain. It can cause strokes or TIAs, especially in young adults.
- Fabry disease: A genetic disorder that can lead to stroke due to the accumulation of a particular type of fat in the walls of blood vessels, including those in the brain. It's rare and typically presents with other systemic symptoms.