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__NOTOC__
__NOTOC__
{{Stroke}}
{{Stroke}}
{{CMG}}; {{AE}} {{MehdiP}}{{AA}},{{TarekNafee}},{{SaraM}}
'''For patient information, click [[Stroke (patient information)|here]]'''
==Overview==
Stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. This can be due to [[ischemia]] (lack of blood supply) caused by [[thrombosis]] or [[embolism]], or due to a [[hemorrhage]].<ref>{{cite book |author=Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Robbins, Stanley L.; Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages= |isbn=0-7216-0187-1}}</ref>


Stroke is a [[medical emergency]] and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated. It is the third leading cause of [[death]] and the leading cause of adult disability in the United States and Europe. It is predicted that stroke will soon become the leading cause of death worldwide.<ref name="feigin2005">{{cite journal |author=Feigin VL |title=Stroke epidemiology in the developing world |journal=Lancet |volume=365 |issue=9478 |pages=2160–1 |year=2005 |pmid=15978910 |doi=10.1016/S0140-6736(05)66755-4}}</ref> [[World Health Organization|WHO]] defines stroke as, a '''neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours'''.
{{CMG}}; {{AE}} {{MHP}}


Risk factors for stroke include [[Old age|advanced age]], [[hypertension]] (high blood pressure), previous stroke or [[transient ischaemic attack]] (TIA), [[diabetes mellitus]], [[Hypercholesterolemia|high cholesterol]], [[cigarette smoking]], [[atrial fibrillation]], [[migraine]]<ref>[http://headaches.about.com/od/migrainediseas1/a/mx_stroke_risk.htm headaches.about.com]</ref> with aura, and [[thrombophilia]]. In clinical practice, blood pressure is the most important modifiable [[risk factor]] of stroke; however many other risk factors, such as cigarette smoking cessation and treatment of [[atrial fibrillation]] with anticoagulant drugs, are important. Treatment of  ischemic stroke is occasionally with [[thrombolysis]], but usually with supportive care ([[physiotherapy]] and [[occupational therapy]]) and secondary prevention with [[antiplatelet drug]]s ([[aspirin]] and often [[dipyridamole]]), blood pressure control, [[statin]]s and [[Anticoagulant|anticoagulation]] (in selected patients).<ref>{{cite journal |author=Hackam DG, Spence JD |title=Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study |journal=Stroke |volume=38 |issue=6 |pages=1881–5 |year=2007 |pmid=17431209 |doi=10.1161/STROKEAHA.106.475525}}</ref> Hemorrhagic stroke is a medical emergency, rapid diagnosis and management is crucial because early deterioration is common in the first few hours after [[ICH]] onset.<ref name="pmid18007267">{{cite journal| author=Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M et al.| title=Prehospital neurologic deterioration in patients with intracerebral hemorrhage. | journal=Crit Care Med | year= 2008 | volume= 36 | issue= 1 | pages= 172-5 | pmid=18007267 | doi=10.1097/01.CCM.0000297876.62464.6B | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18007267  }}</ref>
{{SK}}  


==Causes==
==[[Stroke overview|Overview]]==
The following table lists causes for stroke.<ref name="pmid17043443">{{cite journal |vauthors=Kishimoto M, Arakawa KC |title=A patient with wegener granulomatosis and intraventricular hemorrhage |journal=J Clin Rheumatol |volume=9 |issue=6 |pages=354–8 |year=2003 |pmid=17043443 |doi=10.1097/01.rhu.0000089967.51779.d7 |url=}}</ref><ref name="pmid7336321">{{cite journal |vauthors=Challa VR, Richards F, Davis CH |title=Intraventricular hemorrhage from pituitary apoplexy |journal=Surg Neurol |volume=16 |issue=5 |pages=360–1 |year=1981 |pmid=7336321 |doi= |url=}}</ref><ref name="pmid18320145">{{cite journal |vauthors=Flint AC, Roebken A, Singh V |title=Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome |journal=Neurocrit Care |volume=8 |issue=3 |pages=330–6 |year=2008 |pmid=18320145 |doi=10.1007/s12028-008-9070-2 |url=}}</ref><ref name="pmid21215656">{{cite journal |vauthors=Fukutake T |title=Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification |journal=J Stroke Cerebrovasc Dis |volume=20 |issue=2 |pages=85–93 |year=2011 |pmid=21215656 |doi=10.1016/j.jstrokecerebrovasdis.2010.11.008 |url=}}</ref><ref name="pmid22858729">{{cite journal| author=Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S et al.| title=SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. | journal=Stroke | year= 2012 | volume= 43 | issue= 10 | pages= 2592-7 | pmid=22858729 | doi=10.1161/STROKEAHA.112.661603 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22858729  }} </ref><ref name="Hart">Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.</ref><ref name="Knudsen">Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539. </ref><ref name="Lovelock">Lovelock, C. E., A. J. Molyneux, and P. M. Rothwell. "Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study." The Lancet Neurology 6.6 (2007): 487-493. </ref><ref name="pmid1117973">{{cite journal| author=Rümke CL| title=Letter: Implications of the statement: No side effects were observed. | journal=N Engl J Med | year= 1975 | volume= 292 | issue= 7 | pages= 372-3 | pmid=1117973 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1117973  }} </ref><ref name="pmid19246695">{{cite journal |vauthors=Hanley DF |title=Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage |journal=Stroke |volume=40 |issue=4 |pages=1533–8 |year=2009 |pmid=19246695 |pmc=2744212 |doi=10.1161/STROKEAHA.108.535419 |url=}}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
==[[Stroke historical perspective|Historical Perspective]]==
! colspan="4" align="center" style="background:#DCDCDC;" |Causes
|-
! align="center" style="background:#DCDCDC;" |Disease
! align="center" style="background:#DCDCDC;" |Lethal causes
! align="center" style="background:#DCDCDC;" |Common causes
! align="center" style="background:#DCDCDC;" |Less common causes
|-
| align="center" style="background:#DCDCDC;" |[[Transient ischemic attack]] (TIA)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Emboli]] from cardiac source (mostly secondary to [[Atrial fibrillation|AF]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atherosclerotic plaque]]
* [[Thrombosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Arterial dissection]]
|-
| align="center" style="background:#DCDCDC;" |[[Ischemic stroke]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atrial fibrillation]]
* [[Eclampsia]]
* [[Infective endocarditis]]
* [[Myocardial infarction]]
* [[Pulmonary embolism]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Aneurysm]]
* [[Arteriovenous malformations]]
* [[Atherosclerosis]]
* [[Atrial fibrillation]]
* [[Embolism]]
* [[Hypertension]]
* [[Subarachnoid hemorrhage]]
* [[Thrombosis]]
* [[Transient ischemic attack]]
* [[Traumatic brain injury]]
* [[Warfarin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Takayasu arteritis]]
* [[Vasculitis]]
* [[Vasoconstriction]]


* [[Infective endocarditis]]
==[[Stroke classification|Classification]]==
* [[Lacunar infarcts]]
* [[Left atrial myxoma]]
|-
| align="center" style="background:#DCDCDC;" |[[Intracerebral hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypertension|Long-standing hypertension]]


* [[Cerebral amyloid angiopathy]]
==[[Stroke pathophysiology|Pathophysiology]]==
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation|Arteriovenous malformations (AVMs)]]
* [[Aneurysms]]


* [[Cocaine]]
==[[Stroke causes|Causes]]==
* [[Amphetamines]]


* [[Vasculitis]]
==[[Stroke differential diagnosis|Differentiating Stroke from other Diseases]]==


* [[Liver disease]]
==[[Stroke epidemiology and demographics|Epidemiology and Demographics]]==
* [[Anticoagulant]] medication
* [[Thrombolytic therapy]]


* [[Tumor|Brain tumor]]
==[[Stroke risk factors|Risk Factors]]==
* Hemorrhagic transformation of an [[ischemic stroke]]
* [[Moyamoya disease]]
* [[Tumor|Tumors]]


* [[Encephalitis]]
==[[Stroke screening|Screening]]==
|-
| align="center" style="background:#DCDCDC;" |[[Subarachnoid hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation]]
* [[Dural arteriovenous fistula]]
* [[Perimesencephalic nonaneurysmal subarachnoid hemorrhage|Perimesencephalic]]
* [[Arterial dissection|Intracranial arterial dissection]]
* [[Amyloid angiopathy]]
* Cerebral [[venous thrombosis]]
* Cerebral [[vasculitis]]
* Reversible vasoconstriction syndrome


* Cerebral hyperperfusion syndrome after [[carotid endarterectomy]]
==[[Stroke natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* Reversible posterior leukoencephalopathy syndrome
* Brain or cervical [[Tumor|tumors]]
* Illicit drug use ([[cocaine]], [[amphetamines]])
|-
| align="center" style="background:#DCDCDC;" |[[Subdural hematoma|Subdural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of bridging vessels
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Aneurysmal [[subarachnoid hemorrhage]]
* [[Arteriovenous malformation]]
* [[Meningioma]]
* Dural metastases
* [[Coagulopathy]]
* Neurosurgical procedures
* [[Cocaine abuse]]
|-
| align="center" style="background:#DCDCDC;" |[[Epidural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of middle meningeal arteries
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| align="center" style="background:#DCDCDC;" |[[Intraparenchymal hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
[[Arteriovenous malformation]]
|-
| align="center" style="background:#DCDCDC;" |[[Intraventricular hemorrhage]] (IVH)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Secondary to [[intracerebral hemorrhage]]
* Trauma (motor vehicle accidents, falls, and assaults)
* Vascular malformations (usually [[Arteriovenous malformation|arteriovenous malformations]] or [[Arteriovenous fistula|arteriovenous fistulae]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Intraventricular tumors ([[papilloma]], neurocytoma, [[meningioma]], metastases, [[astrocytoma]], [[ependymoma]])
* Intraventricular aneurysms
* [[Moyamoya disease]]
* [[Pituitary apoplexy]]
* [[Vasculitis]]
|}


==Classification==
==Diagnosis==
===Transient ischemic attack===
[[Stroke  diagnostic study of choice|Diagnostic study of choice]] | [[Stroke history and symptoms|History and Symptoms]] | [[Stroke physical examination|Physical Examination]] | [[Stroke laboratory findings|Laboratory Findings]] | [[Stroke electrocardiogram|Electrocardiogram]] | [[Stroke x ray|X-Ray Findings]] | [[Stroke echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Stroke CT scan|CT-Scan Findings]] | [[Stroke MRI|MRI Findings]] | [[Stroke other imaging findings|Other Imaging Findings]] | [[Stroke other diagnostic studies|Other Diagnostic Studies]]
*A transient ischemic attack is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours.
===Stroke===
{{familytree/start |summary=Stroke}}
{{familytree | | | | | | | | | | | | | | | | A01 |A01='''Stroke'''}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | | B01 | | | | | | | | | | | | | | | | | | | B02 | | |B01=[[Ischemic stroke|Ischemic]]|B02=[[Hemorrhagic stroke|Hemorrhagic]]}}
{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.|}}
{{familytree | D01 | | D02 | | D03 | | D04 | | | | | | | | | | | | | | | | | | | D05 |D01=Large vessel thromboembolism|D02=Cardioembolic|D03=Small vessel or Lacunar infarct|D04=Intra-axial|D05=Extra-axial}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |!|}}
{{familytree | | | | | | | | | | | | | |)|-|-|-|-|.|,|-|-|-|-|-|-|-|-|v|-|-|-|-|-|^|-|-|-|-|.}}
{{familytree | | | | | | | | | | | | | E01 | | | E02 | | | | | | | | E03 | | | | | | | | | E04 |E01=[[Intracerebral hemorrhage|Intracerebral]] (ICH)|E02=[[Subarachnoid hemorrhage]] (SAH)|E03=[[Subdural hematoma|Subdural Hemorrhage]]|E04=[[Epidural hematoma|Epidural Hemorrhage]]}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | | |}}
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | | | | | F01 | | | | | F02 | | | | | F03 |F01=[[Intraparenchymal hemorrhage|Intraparenchymal hemorrhage]]|F02=[[Intraventricular hemorrhage]] (IVH)|F03=Cerebral microbleeds
}}
{{familytree/end}}
 
==Differential diagnosis==
Stroke, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the differential diagnosis for stroke:
{|
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical Examination
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diagnostic tests
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other Findings
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Headache
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |↓ LOC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor weakness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abnormal sensory
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Motor Deficit
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensory deficit
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Speech difficulty
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gait abnormality
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cranial nerves
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT/MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CSF
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard test
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain tumor]]<ref name="pmid105826682">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }}</ref><ref name="pmid213713272">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
| align="left" style="background:#F5F5F5;" |
*[[Weight loss]]
*[[Fatigue]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Cancer cells
| align="center" style="background:#F5F5F5;" |MRI
| align="left" style="background:#F5F5F5;" |
*[[Cachexia]]
*Gradual progression of symptoms
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]<ref name="pmid216947552">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid218073452">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
| align="left" style="background:#F5F5F5;" |
*[[Hypertension]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |CT scan without contrast
| align="left" style="background:#F5F5F5;" |
*[[Neck stiffness]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Subdural hematoma|Subdural hemorrhage]]<ref name="pmid216947552" /><ref name="pmid218073452" /><ref name="pmid11986282">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
| align="left" style="background:#F5F5F5;" |
*[[Trauma]]
*Fall
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |[[Xanthochromia]]
| align="center" style="background:#F5F5F5;" |CT scan without contrast
| align="left" style="background:#F5F5F5;" |
*[[Confusion]]
*[[Dizziness]]
*[[Nausea and vomiting]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid224828242">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }}</ref><ref name="pmid243654302">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref><ref name="pmid224216972">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
| align="left" style="background:#F5F5F5;" |
*[[Sexually transmitted disease]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ [[Leukocytes]] and [[protein]]
| align="center" style="background:#F5F5F5;" |Specific: CSF [[VDRL]]
Sensitive: CSF FTA-Ab
| align="left" style="background:#F5F5F5;" |
*[[Blindness]]
*[[Confusion]]
*[[Depression]]
*Abnormal [[gait]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
| align="left" style="background:#F5F5F5;" |
*Family history of [[migraine]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical assesment
| align="left" style="background:#F5F5F5;" |
*Presence of [[aura]]
*[[Nausea and vomiting]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
| align="left" style="background:#F5F5F5;" |
*[[Hypertension]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical assesment
| align="left" style="background:#F5F5F5;" |
*[[Delirium]]
*Cortical [[blindness]]
*[[Cerebral edema]]
*[[Seizure]]
|-
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
| align="left" style="background:#F5F5F5;" |
*History of alcohal abuse
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical assesment and lab findings
| align="left" style="background:#F5F5F5;" |
*[[Ophthalmoplegia]]
*[[Confusion]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
| align="left" style="background:#F5F5F5;" |
*History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ leukocytes, ↓ glucose and ↑ protien
| align="center" style="background:#F5F5F5;" |MRI is more sensitive and specific
| align="left" style="background:#F5F5F5;" |
*High grade [[fever]]
*[[fatigue]]
*Nausea and vomiting
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
| align="left" style="background:#F5F5F5;" |Medication history of
*[[Lithium]]
*[[Sedatives]]
*[[Phenytoin]]
*[[Carbamazepine]]
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Drug screen test
| align="center" style="background:#F5F5F5;" |–
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
| align="center" style="background:#F5F5F5;" |
*History of [[emotional stress]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Diagnosis of exclusion
| align="left" style="background:#F5F5F5;" |
*[[Tremor]]
*[[Blindness]]
*Difficulty [[swallowing]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |[[Hypoglycemia]], [[hyponatremia]], [[hypernatremia]], [[hypokalemia]], and [[hyperkalemia]]
| align="center" style="background:#F5F5F5;" |Depends on the cause
| align="left" style="background:#F5F5F5;" |
*[[Confusion]]
*[[Seizure]]
*[[Palpitation]]
*[[Sweating]]
*[[Dizziness]]
*[[Hypoglycemia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] or [[encephalitis]]<ref name="pmid193982862">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
| align="left" style="background:#F5F5F5;" |
*History of [[fever]] and [[malaise]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |↑ Leukocytes, ↑ protein, ↓ glucose
| align="center" style="background:#F5F5F5;" |[[CSF analysis]]
| align="left" style="background:#F5F5F5;" |
*[[Fever]]
*Neck rigidity
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid82741112">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
| align="left" style="background:#F5F5F5;" |
*History of relapses and remissions
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑ CSF IgG levels, (monoclonal bands)
| align="center" style="background:#F5F5F5;" |Clinical assesment and [[MRI]]
| align="left" style="background:#F5F5F5;" |
*Blurry [[vision]]
*[[Urinary incontinence]]
*[[Fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]<ref name="pmid113850432">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
| align="center" style="background:#F5F5F5;" |
*Previous history of [[seizures]]
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |Mass lesion
| align="center" style="background:#F5F5F5;" |Clinical assesment and [[EEG]]
| align="left" style="background:#F5F5F5;" |
*[[Confusion]]
*[[Apathy]]
*[[Irritability]]
|}
 
== Differential diagnosis ==
 
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="8" |<small>History and Physical
! colspan="2" |<small>Diagnostic tests</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Cranial nerve Involvement</small>
!<small>Autonomic dysfunction</small>
!<small>Proximal/Distal/Generalized</small>
!<small>Ascending/Descending/Systemic</small>
!Side
!<small>Onset</small>
!<small>Lab or Imaging Findings</small>
!<small>Specific  test</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]<ref name="pmid8848683">{{cite journal| author=Kuntzer T, Hirt L, Bogousslavsky J| title=[Neuromuscular involvement and cerebrovascular accidents]. | journal=Rev Med Suisse Romande | year= 1996 | volume= 116 | issue= 8 | pages= 605-9 | pmid=8848683 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8848683  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+/-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | MRI +ve for ischemia or hemorrhage
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors (diabetes, hypertension, smoking) or [[Atrial fibrillation|atrial fibrillation.]]<nowiki/>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[Hyporeflexia|Hyporeflexia,]] [[Hypotonia]], possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Descending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test
| style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Flaccid paralysis]] ([[Floppy baby syndrome]]), possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]]<ref name="pmid22081202">{{cite journal| author=Talukder RK, Sutradhar SR, Rahman KM, Uddin MJ, Akhter H| title=Guillian-Barre syndrome. | journal=Mymensingh Med J | year= 2011 | volume= 20 | issue= 4 | pages= 748-56 | pmid=22081202 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22081202  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein


↓Cells
==Treatment==
 
[[Stroke medical therapy|Medical Therapy]] | [[Stroke interventions|Interventions]] | [[Stroke surgery|Surgery]] | [[Stroke primary prevention|Primary Prevention]] | [[Stroke secondary prevention|Secondary Prevention]] | [[Stroke cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stroke future or investigational therapies|Future or Investigational Therapies]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical & Lumbar Puncture
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive [[ascending paralysis]] following infection, possible respiratory paralysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]]<ref name="pmid27412406">{{cite journal| author=Merino-Ramírez MÁ, Bolton CF| title=Review of the Diagnostic Challenges of Lambert-Eaton Syndrome Revealed Through Three Case Reports. | journal=Can J Neurol Sci | year= 2016 | volume= 43 | issue= 5 | pages= 635-47 | pmid=27412406 | doi=10.1017/cjn.2016.268 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27412406  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[EMG]], repetitive nerve stimulation test (RNS)
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Voltage gated calcium channel|Voltage gated calcium channe]]<nowiki/>l<nowiki/> (VGCC) antibody<nowiki/><nowiki/>
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], improves with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]]<ref name="pmid28029925">{{cite journal| author=Gilhus NE| title=Myasthenia Gravis. | journal=N Engl J Med | year= 2016 | volume= 375 | issue= 26 | pages= 2570-2581 | pmid=28029925 | doi=10.1056/NEJMra1602678 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28029925  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent
| style="background: #F5F5F5; padding: 5px; text-align:center" | [[Electromyography|EMG]], [[Edrophonium|Edrophonium test]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Acetylcholine receptor|Ach receptor]] antibody
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Diplopia]], [[ptosis]], worsening with movement (as the day progresses)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]]<ref name="pmid26813501">{{cite journal| author=Ozono K| title=[Diagnostic criteria for vitamin D-deficient rickets and hypocalcemia-]. | journal=Clin Calcium | year= 2016 | volume= 26 | issue= 2 | pages= 215-22 | pmid=26813501 | doi=CliCa1602215222 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26813501 }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓Ca++, ↓Mg++, ↓K+
| style="background: #F5F5F5; padding: 5px; text-align:center" |Possible [[arrhythmia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]]<ref name="pmid15020723">{{cite journal| author=Kamanyire R, Karalliedde L| title=Organophosphate toxicity and occupational exposure. | journal=Occup Med (Lond) | year= 2004 | volume= 54 | issue= 2 | pages= 69-75 | pmid=15020723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15020723  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical suspicion confirmed with RBC AchE activity
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of exposure to i[[Insecticide|nsecticide]] or living in farming environment. with : [[Diarrhea]], [[Urination]], [[Miosis]], [[Bradycardia]], [[Lacrimation]], [[Emesis]], [[Salivation]], [[Sweating]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]])<ref name="pmid23677663">{{cite journal| author=Pecina CA| title=Tick paralysis. | journal=Semin Neurol | year= 2012 | volume= 32 | issue= 5 | pages= 531-2 | pmid=23677663 | doi=10.1055/s-0033-1334474 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23677663  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Ascending
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & history
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of outdoor activity in Northeastern United States. The tick is often still latched to the patient at presentation (often in head and neck area)
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning<ref name="pmid24566728">{{cite journal| author=Bane V, Lehane M, Dikshit M, O'Riordan A, Furey A| title=Tetrodotoxin: chemistry, toxicity, source, distribution and detection. | journal=Toxins (Basel) | year= 2014 | volume= 6 | issue= 2 | pages= 693-755 | pmid=24566728 | doi=10.3390/toxins6020693 | pmc=3942760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24566728  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" | Clinical diagnosis: physical exam & dietary history
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | History of consumption of puffer fish species.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]]<ref name="pmid19944665">{{cite journal| author=Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J| title=Aging and sequelae of poliomyelitis. | journal=Ann Phys Rehabil Med | year= 2010 | volume= 53 | issue= 1 | pages= 24-33 | pmid=19944665 | doi=10.1016/j.rehab.2009.10.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19944665  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |PCR of CSF
| style="background: #F5F5F5; padding: 5px; text-align:center" |Asymmetric paralysis following a flu-like syndrome.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Transverse myelitis]]<ref name="pmid24099672">{{cite journal| author=West TW| title=Transverse myelitis--a review of the presentation, diagnosis, and initial management. | journal=Discov Med | year= 2013 | volume= 16 | issue= 88 | pages= 167-77 | pmid=24099672 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24099672  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL or UL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of chronic viral or autoimmune disease (e.g. [[HIV]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | +/-
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/>
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc
CSF [[FTA-ABS|FTA-Ab]] -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |History of unprotected sex or multiple sexual partners.
 
History of [[genital ulcer]] ([[chancre]]), diffuse [[Maculopapular rash|maculopapular ras]]<nowiki/>h.
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]]<ref name="pmid26457695">{{cite journal| author=Falzarano MS, Scotton C, Passarelli C, Ferlini A| title=Duchenne Muscular Dystrophy: From Diagnosis to Therapy. | journal=Molecules | year= 2015 | volume= 20 | issue= 10 | pages= 18168-84 | pmid=26457695 | doi=10.3390/molecules201018168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26457695  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Genetic testing
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal lower limb weakness with calf pseudohypertrophy in early childhood. [[Gowers' sign|Gower sign]] positive.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation<ref name="pmid27432676">{{cite journal| author=Filippi M, Preziosa P, Rocca MA| title=Multiple sclerosis. | journal=Handb Clin Neurol | year= 2016 | volume= 135 | issue=  | pages= 399-423 | pmid=27432676 | doi=10.1016/B978-0-444-53485-9.00020-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27432676  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |NL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''[[CSF|↑]]'''[[CSF]] [[IgG]] levels
(monoclonal)
| style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical assessment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]]<ref name="pmid27025851">{{cite journal| author=Riva N, Agosta F, Lunetta C, Filippi M, Quattrini A| title=Recent advances in amyotrophic lateral sclerosis. | journal=J Neurol | year= 2016 | volume= 263 | issue= 6 | pages= 1241-54 | pmid=27025851 | doi=10.1007/s00415-016-8091-6 | pmc=4893385 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27025851  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Generalized
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" | Normal [[Lumbar puncture|LP]] (to rule out DDx)
| style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & [[Lumbar puncture|LP]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Patient initially presents with [[upper motor neuron]] deficit ([[spasticity]]) followed by [[lower motor neuron]] deficit ([[flaccidity]]).
|-
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis|Inflammatory myopathy]]<ref name="pmid26290112">{{cite journal| author=Michelle EH, Mammen AL| title=Myositis Mimics. | journal=Curr Rheumatol Rep | year= 2015 | volume= 17 | issue= 10 | pages= 63 | pmid=26290112 | doi=10.1007/s11926-015-0541-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26290112  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align:center" |Proximal > Distal
| style="background: #F5F5F5; padding: 5px; text-align:center" |Systemic
| style="background: #F5F5F5; padding: 5px; text-align:center" |UL or BL
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious
| style="background: #F5F5F5; padding: 5px; text-align:center" |Elevated [[Creatine kinase|CK]] & [[Aldolase]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |[[Muscle biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |Progressive proximal muscle weakness in 3rd to 5th decade of life. With or without skin manifestations.
|-
|}
 
==Epidemiology and Demographics ==
===Stroke in USA===
*Stroke is a leading cause of serious long-term disability
*In USA, the incidence and mortality rates of stroke has significantly decreased compared to previous years.
*From year 2003 to 2013, the mortality rates due to stroke declined by 18.5%.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
*In 2013, stroke became the fifth leading cause of death.
*The case fatality rate of stroke is estimated to be 41.7 deaths per 100, 000 population<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
*The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
*It is estimated that one incidence of stroke happens every 4 sec with death occurs every 4 min.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
*About 87% of all strokes are ischemic strokes<ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*Stroke costs the United States an estimated $34 billion each year<ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
===Worldwide===
*According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.<ref name="WHOSTROKE">Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
*Out of these, 5 million die and 5 million are left permanently disabled.<ref name="WHOSTROKE">Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
===Age===
*Stroke can occur in all age groups. However, the incidence of stroke is less among individuals age less than 40 years of age and the risk increases with increasing age. <ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*According to [[WHO]], stroke also occurs in about 8% of children with [[sickle cell disease]].<ref name="WHOSTROKE">Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
*In 2009, 34% of people hospitalized for stroke were younger than 65 years<ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. <ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
 
* The rate of decline in mortality rates of stroke in different age groups is as follows:<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
 
**Older then 65 years: from 534.1 to 245.2 per 100,000
**45-65 years of age: from 43.5 to 20.2 per 100,000
**18 to 44 years of age: from  from 3.7 to 2.0 per 100,000
===Gender===
There is increased incidence of stroke in men as compared to women.
===Race===
*The risk of incidence of first stroke is twice in African-American population as compared to Caucasians with increased mortality rates.<ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
===Geographical distribution===
*There is increased incidence and mortality rates of stroke in developing countries as compared to developed countries due to low socioeconomic status and heath facilities.
*In the USA, the highest death rates from stroke are in the southeastern United States.<ref name="CDCstroke">http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
 
==Diagnosis==
Almost 10% of cerebrovascular events that present to the emergency department are not detected during evaluation.<ref name="pmid28356464">{{cite journal| author=Tarnutzer AA, Lee SH, Robinson KA, Wang Z, Edlow JA, Newman-Toker DE| title=ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: A meta-analysis. | journal=Neurology | year= 2017 | volume= 88 | issue= 15 | pages= 1468-1477 | pmid=28356464 | doi=10.1212/WNL.0000000000003814 | pmc=5386439 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28356464  }} </ref> This is more common when "presenting neurologic complaints are mild, nonspecific, or transient".<ref name="pmid28356464" />
*Diagnosis is based on history of symptoms development, physical examination and imaging findings.
*[[CT scan]] and [[magnetic resonance imaging]] (MRI) are both reasonable for initial evaluation.
*[[CT scan]] without contrast is the initial test performed to diagnose [[ischemic stroke]] and rule out [[hemorrhagic stroke]].
*[[CT]] is very sensitive for identifying acute [[hemorrhage]] and is considered the gold standard.
*Gradient [[echo]] and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
*[[MR diffusion weighted imaging]] is the most sensitive and specific test for diagnosing [[ischemic stroke]] and may help detect presence of [[infarction]] in few minutes of onset of symptoms. It may also help differentiate viable tissue from infarct area if combined with MR perfusion. For diagnosing [[ischemic stroke]] in the emergency setting, [[MRI]] scan has the sensitivity and specificity of 83% and 98% respectively.<ref name="pmid17258669">{{cite journal |vauthors=Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S |title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison |journal=Lancet |volume=369 |issue=9558 |pages=293–8 |year=2007 |pmid=17258669 |pmc=1859855 |doi=10.1016/S0140-6736(07)60151-2 |url=}}</ref>
*[[MRI scan]] is superior to [[CT scan]] for being more sensitive and specific in detection of [[Lacunar infarcts|lacunar]] and posterior fossa infarcts, differentiation between acute and chronic stroke and detection of microbleeds. Another additional advantage is absence of [[Ionizing radiation|ionising radiation]] compared to CT scan. Some of the disadvantages of [[MRI scan]] may include lack of availability in acute setting, higher cost, inability to use it in patients with metallic implants. MRI with contrast cannot be used in patients with [[renal failure]].<ref name="pmid23907247">{{cite journal| author=Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW et al.| title=Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. | journal=AJNR Am J Neuroradiol | year= 2013 | volume= 34 | issue= 11 | pages= E117-27 | pmid=23907247 | doi=10.3174/ajnr.A3690 | pmc=4072500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23907247  }} </ref><ref name="pmid20974371">{{cite journal| author=Leiva-Salinas C, Wintermark M| title=Imaging of acute ischemic stroke. | journal=Neuroimaging Clin N Am | year= 2010 | volume= 20 | issue= 4 | pages= 455-68 | pmid=20974371 | doi=10.1016/j.nic.2010.07.002 | pmc=2965616 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20974371  }} </ref>


==References==
==Case Studies==
{{reflist|2}}
[[Stroke case study one|Case #1]]


{{WS}}
[[Category: (name of the system)]]
{{WH}}

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