1. Stroke and stroke mimics Applied Neuroanatomy

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

3. 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

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

5. Left – global aphasia Right - neglect

6. Left – receptive aphasia Right – minimal weakness

7. Left – expressive aphasia Right - neglect

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

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

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

11. 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

12. 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.