IngentaConnect Clinically presenting acute/subacute ischemic stroke: differentia...

Authors: Misra, Vivek¹; Fadil, Halim¹; Hoque, Romy¹; Menon, Uma¹; Gonzalez-Toledo, Eduardo²; Jaffe, Stephen³

Source: Neurological Research, Volume 31, Number 8, October 2009 , pp. 816-823(8)

Abstract:

Objectives: Patients presenting to the emergency room with an acute or subacute onset of focal neurological deficits are evaluated initially by non-contrast computed tomogram (CT) of the brain. This is primarily carried out to differentiate an ischemic from hemorrhagic stroke. However, other neurological conditions may have a similar clinical presentation as well as only hypodensities on CT scan, thus mimicking ischemic stroke. This review focuses on the advanced neuroimaging modalities that help differentiate these other conditions from a cerebral infarction.

Methods: The literature was reviewed in order to ascertain what conditions would clinically and by CT mimic an acute/subacute ischemic infarction, and what advanced neuroimaging techniques would be most useful in differentiating these conditions.

Results: Several infectious, inflammatory, metabolic and vascular diseases were found with clinical presentations identical to subacute/acute ischemic cerebral infarction, which also could demonstrate only hypodensities on a non-enhanced CT scan. However, advanced neuroimaging techniques could readily differentiate these conditions from ischemic infarction.

Conclusions: As presented in this review, although several diseases initially present a diagnostic dilemma upon presentation because of their clinical and non-enhanced CT similarities to cerebral infarction, advanced diagnostic neuroimaging readily establishes their unique pathologies.

Keywords: ISCHEMIC STROKE; CT; NEUROIMAGING; DIFFERENTIAL DIAGNOSIS

Document Type: Research article

DOI: 10.1179/016164109X12445505689607

Affiliations: 1: Department of Neurology, Louisiana State University School of Medicine in Shreveport, Shreveport, LA, USA 2: Department of Neurology, Department of Radiology, Louisiana State University School of Medicine in Shreveport, Shreveport, LA, USA 3: Department of Neurology, Louisiana State University School of Medicine in Shreveport, 1501 Kings Highway, Shreveport, LA 71130, USA;, Email: sjaffe1@lsuhsc.edu

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Clinically presenting acute/subacute ischemic stroke: differential diagnosis of the non-enhanced CT hypodensity by advanced neuroimaging