Differential Diagnosis for Non-Infective Causes of Acute CVA

Single Most Likely Diagnosis

• Atherosclerotic Disease: This is the most common cause of acute cerebral vascular accidents (CVAs) or strokes, particularly in older adults. The buildup of plaque in the arteries leading to the brain can lead to ischemic stroke, which accounts for the majority of stroke cases.

Other Likely Diagnoses

• Cardioembolic Stroke: Conditions like atrial fibrillation can lead to the formation of blood clots in the heart, which can then travel to the brain, causing an embolic stroke. This is a common cause of stroke, especially in patients with known heart disease.
• Hypertensive Encephalopathy: Severe hypertension can lead to stroke by causing damage to the blood vessels in the brain, leading to either ischemia or hemorrhage.
• Vasculitis: Inflammation of the blood vessels can lead to stroke by damaging the vessels and reducing blood flow to parts of the brain.

Do Not Miss Diagnoses

• Reversible Cerebral Vasoconstriction Syndrome (RCVS): Although less common, RCVS can mimic other causes of stroke and is crucial to diagnose because it requires specific treatment to prevent further episodes.
• Cervical Artery Dissection: A tear in the lining of one of the arteries in the neck can lead to stroke. This condition is often associated with trauma but can also occur spontaneously.
• 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.

Rare Diagnoses

• Fabry Disease: A genetic disorder that can lead to stroke due to the accumulation of a particular type of fat in the blood vessels.
• CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): An inherited condition that affects the blood vessels in the brain, leading to subcortical strokes and dementia.
• MELAS Syndrome (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes): A rare mitochondrial disorder that can cause stroke-like episodes, among other symptoms.