Hemorrhagic stroke differential diagnosis: Difference between revisions

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==Differential diagnosis==
==Differential diagnosis==
 
<ref name="pmid9810961">{{cite journal| author=Linn FH, Rinkel GJ, Algra A, van Gijn J| title=Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. | journal=J Neurol Neurosurg Psychiatry | year= 1998 | volume= 65 | issue= 5 | pages= 791-3 | pmid=9810961 | doi= | pmc=2170334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9810961  }} </ref><ref name="pmid1783930">{{cite journal| author=Markus HS| title=A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 12 | pages= 1117-8 | pmid=1783930 | doi= | pmc=1014694 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1783930  }} </ref>
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*Urgent evaluation with  [[MRI]] and [[CT]] of the brain, serum [[creatinine]], [[urinalysis]], cardiac ([[EKG]], [[chest x ray]], and c[[ardiac enzymes]]) and metabolic evaluation is often necessary
*Urgent evaluation with  [[MRI]] and [[CT]] of the brain, serum [[creatinine]], [[urinalysis]], cardiac ([[EKG]], [[chest x ray]], and c[[ardiac enzymes]]) and metabolic evaluation is often necessary
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| style="padding: 5px 5px; background: #DCDCDC;" |'''Sentinel headache'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Sentinel headache'''<ref name="pmid14984225">{{cite journal| author=Polmear A| title=Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. | journal=Cephalalgia | year= 2003 | volume= 23 | issue= 10 | pages= 935-41 | pmid=14984225 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14984225  }} </ref>
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*Caused by small aneurysmal leaks into the subarachnoid space
*Caused by small aneurysmal leaks into the subarachnoid space
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*
*
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Pituitary apoplexy]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Pituitary apoplexy]]'''<ref name="pmid9596029">{{cite journal| author=Dodick DW, Wijdicks EF| title=Pituitary apoplexy presenting as a thunderclap headache. | journal=Neurology | year= 1998 | volume= 50 | issue= 5 | pages= 1510-1 | pmid=9596029 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9596029  }} </ref>
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*Caused by pituitary gland infarct or hemorrhage secondary to [[pitutiery adenoma]]  
*Caused by pituitary gland infarct or hemorrhage secondary to [[pitutiery adenoma]]  
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**Brain CT and MRI are the preferred imaging techniques  
**Brain CT and MRI are the preferred imaging techniques  
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cerebral venous thrombosis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Cerebral venous thrombosis]]'''<ref name="pmid8961993">{{cite journal| author=de Bruijn SF, Stam J, Kappelle LJ| title=Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. | journal=Lancet | year= 1996 | volume= 348 | issue= 9042 | pages= 1623-5 | pmid=8961993 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8961993  }} </ref><ref name="pmid3975957">{{cite journal| author=Bousser MG, Chiras J, Bories J, Castaigne P| title=Cerebral venous thrombosis--a review of 38 cases. | journal=Stroke | year= 1985 | volume= 16 | issue= 2 | pages= 199-213 | pmid=3975957 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3975957  }} </ref>
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*Presents with isolated gradual onset headache or in combination with [[papilledema]], [[seizures]], bilateral focal deficits, and change in mental status  
*Presents with isolated gradual onset headache or in combination with [[papilledema]], [[seizures]], bilateral focal deficits, and change in mental status  
*Brain MRI with venography should be considered  
*Brain MRI with venography should be considered  
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Colloid cyst|Colloid cyst of the third ventricle]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Colloid cyst|Colloid cyst of the third ventricle]]'''<ref name="pmid14830663">{{cite journal| author=KELLY R| title=Colloid cysts of the third ventricle; analysis of twenty-nine cases. | journal=Brain | year= 1951 | volume= 74 | issue= 1 | pages= 23-65 | pmid=14830663 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14830663  }} </ref>
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*Caused by an acute [[obstructive hydrocephalus]] secondary to sudden obstruction in cerebrospinal fluid flow by the cyst  
*Caused by an acute [[obstructive hydrocephalus]] secondary to sudden obstruction in cerebrospinal fluid flow by the cyst  
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*Head CT or MRI of the brain are usually diagnostic
*Head CT or MRI of the brain are usually diagnostic
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[dissection|Cervical artery dissectio]]n'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[dissection|Cervical artery dissection]]'''<ref name="pmid1423556">{{cite journal| author=Mitsias P, Ramadan NM| title=Headache in ischemic cerebrovascular disease. Part I: Clinical features. | journal=Cephalalgia | year= 1992 | volume= 12 | issue= 5 | pages= 269-74 | pmid=1423556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1423556  }} </ref><ref name="pmid14638953">{{cite journal| author=Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL et al.| title=Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. | journal=Neurology | year= 2003 | volume= 61 | issue= 10 | pages= 1347-51 | pmid=14638953 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14638953  }} </ref>
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*It usulay occurs spontaneously or after head and neck injury
*It usulay occurs spontaneously or after head and neck injury
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*Neuroimagings are usually preferred  (brain MRI with MRA and cranial CT with CTA)  
*Neuroimagings are usually preferred  (brain MRI with MRA and cranial CT with CTA)  
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[intracranial hypotension|Spontaneous intracranial hypotension]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[intracranial hypotension|Spontaneous intracranial hypotension]]'''<ref name="pmid1549206">{{cite journal| author=Rando TA, Fishman RA| title=Spontaneous intracranial hypotension: report of two cases and review of the literature. | journal=Neurology | year= 1992 | volume= 42 | issue= 3 Pt 1 | pages= 481-7 | pmid=1549206 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1549206  }} </ref><ref name="pmid11270540">{{cite journal| author=Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK| title=Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. | journal=Neurosurgery | year= 2001 | volume= 48 | issue= 3 | pages= 513-6; discussion 516-7 | pmid=11270540 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11270540  }} </ref>
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*Presents with orthostatic headaches, nausea, vomiting, dizziness,  diplopia, interscapular pain
*Presents with orthostatic headaches, nausea, vomiting, dizziness,  diplopia, interscapular pain

Revision as of 17:01, 3 November 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differential diagnosis

[1][2]

Disease Findings
Ischemic stroke
  • Occurs when a clot or a mass clogs a blood vessel and cutting off the blood flow to the brain
  • Present as a
    • Thrombotic stroke (thrombus develops at the clogged part of the vessel)
    • Embolic strokes (blood clot that forms at another locations usually the heart and large arteries of the upper chest and neck, and travels to the brain)
  • Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
transient ischemic attack (TIA)
  • Caused by a temporary clot which often called a “mini stroke”
  • Occurs rapidly and presents as a sudden onset of a focal neurologic symptom/sign lasting less than 24 hours
  • Urgent evaluation with brain / neurovascular imaging (such as MRI, CT, CTA, MRA), cardiac, and metabolic evaluation is often necessary
Acute hypertensive crisis/Malignant hypertension
  • Presents as significantly elevated blood pressure (systolic pressure ≥180 and/or diastolic pressure ≥120 mmHg) with or wihout acute end-organ injury
  • Urgent evaluation with MRI and CT of the brain, serum creatinine, urinalysis, cardiac (EKG, chest x ray, and cardiac enzymes) and metabolic evaluation is often necessary
Sentinel headache[3]
  • Caused by small aneurysmal leaks into the subarachnoid space
  • Presents as a episode of headache similar to that accompanying subarachnoid hemorrhage (days to weeks prior to aneurysm rupture) and focal neurologic symptoms and signs are usually absent
Sinusitis
  • Presents with acute and subacute headaches and facial pain
Hypoglycemia
Pituitary apoplexy[4]
  • Caused by pituitary gland infarct or hemorrhage secondary to pitutiery adenoma
  • Presents with acute headache, change in mental status, ophthalmoplegia, and decreased visual acuity
    • Brain CT and MRI are the preferred imaging techniques
Cerebral venous thrombosis[5][6]
  • Presents with isolated gradual onset headache or in combination with papilledema, seizures, bilateral focal deficits, and change in mental status
  • Brain MRI with venography should be considered
Colloid cyst of the third ventricle[7]
  • Caused by an acute obstructive hydrocephalus secondary to sudden obstruction in cerebrospinal fluid flow by the cyst
  • Presents with an acute onset fronto-parietal or fronto-occipital headache which relieved by taking the supine position and may be associated with nausea, vomiting, mental status changes, seizures, coma
  • Head CT or MRI of the brain are usually diagnostic
Cervical artery dissection[8][9]
  • It usulay occurs spontaneously or after head and neck injury
  • Presents with gradual onset head and neck pain with a local manifestations (such as Horner syndrome, pulsatile tinnitus, bruit, or cranial neuropathies)
  • Neuroimagings are usually preferred (brain MRI with MRA and cranial CT with CTA)
Spontaneous intracranial hypotension[10][11]
  • Presents with orthostatic headaches, nausea, vomiting, dizziness, diplopia, interscapular pain
  • Caused by cerebrospinal fluid (CSF) leakage from spinal meningeal defects or dural tears
  • Brain MRI is the preferred imaging techniques

References

  1. ↑ Linn FH, Rinkel GJ, Algra A, van Gijn J (1998). "Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache". J Neurol Neurosurg Psychiatry. 65 (5): 791–3. PMC 2170334. PMID 9810961.
  2. ↑ Markus HS (1991). "A prospective follow up of thunderclap headache mimicking subarachnoid haemorrhage". J Neurol Neurosurg Psychiatry. 54 (12): 1117–8. PMC 1014694. PMID 1783930.
  3. ↑ Polmear A (2003). "Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review". Cephalalgia. 23 (10): 935–41. PMID 14984225.
  4. ↑ Dodick DW, Wijdicks EF (1998). "Pituitary apoplexy presenting as a thunderclap headache". Neurology. 50 (5): 1510–1. PMID 9596029.
  5. ↑ de Bruijn SF, Stam J, Kappelle LJ (1996). "Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group". Lancet. 348 (9042): 1623–5. PMID 8961993.
  6. ↑ Bousser MG, Chiras J, Bories J, Castaigne P (1985). "Cerebral venous thrombosis--a review of 38 cases". Stroke. 16 (2): 199–213. PMID 3975957.
  7. ↑ KELLY R (1951). "Colloid cysts of the third ventricle; analysis of twenty-nine cases". Brain. 74 (1): 23–65. PMID 14830663.
  8. ↑ Mitsias P, Ramadan NM (1992). "Headache in ischemic cerebrovascular disease. Part I: Clinical features". Cephalalgia. 12 (5): 269–74. PMID 1423556.
  9. ↑ Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL; et al. (2003). "Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study". Neurology. 61 (10): 1347–51. PMID 14638953.
  10. ↑ Rando TA, Fishman RA (1992). "Spontaneous intracranial hypotension: report of two cases and review of the literature". Neurology. 42 (3 Pt 1): 481–7. PMID 1549206.
  11. ↑ Schievink WI, Wijdicks EF, Meyer FB, Sonntag VK (2001). "Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage". Neurosurgery. 48 (3): 513–6, discussion 516-7. PMID 11270540.


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