Stroke and stroke mimics Applied Neuroanatomy

Stroke Infarction 75% –Unknown 50% –Lacunar 25% –Embolic 20% –Atherosclerotic 5% Haemorrhage 25% –ICH 50% –SAH 50%

Stroke mimics 20% misdiagnosis on H&E Common mimics –Seizures –Sepsis –Metabolic (hypoglycaemia) –SOL –Syncope/presyncope Metabolic/septic – focal neurology in patient with old stroke

Stroke syndromes: MCA Contralateral: –Hemiplegia –Hemisensory loss –Homonymous hemianopia –Face/arm > leg

Left – global aphasia Right - neglect

Left – receptive aphasia Right – minimal weakness

Left – expressive aphasia Right - neglect

Anterior cerebral artery Paralysis contralateral leg and foot Confusion Abulia Grasp reflex Behavioural distrubance Urinary incontinence

Posterior cerebral artery Hemianopia Quadrantinopias Cortical blindness Memory loss Dyslexia Hemisensory loss Ipsilateral third nerve palsy

Vertebrobasilar infarction Cerebellar/brainstem lesions Ataxia Dizziness Nausea/vomiting Nystagmus Cranial nerve palsies Internuclear opthalmoplegia

Lacunar infarctions Small infarcts from short penetrating arterioles Localised motor OR sensory deficit Assoc HTN and poorly controlled type 2 DM (endothelial dysfunction) Good prognosis

The bottom line An ischaemic stroke will have a vascular territory If you can’t tell which vascular territory it is, think hard about stroke mimics.