Professional Documents
Culture Documents
and
Since 1995
rt-PA era
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But...
Stroke. 2009;40:1522-1525
Stroke mimicker
Stroke mimic is the term employed for The mimics include both processes
manifestations of nonvascular disease processes when a stroke-like clinical picture is produced occurring within the CNS and systemic events
800 consecutive patients admitted to a stroke unit from the emergency department of a Canadian hospital They found the initial diagnosis of stroke incorrect in 13% of patients
Ay H et al. Neurology. 1999;52:1784-1792.
Todds paresis (post-ictal paralysis) is focal weakness in a part of the body after a seizure Common in generalized tonic clonic seizure, or partial seizure occur in 13% of the seizure patient recovery within 36 hours
Post-stroke seizure
or Todds paralysis
Stroke can produce seizures
Saturday, May 11, 2013
Some clinical clues to differentiate both what come rst; weak or seizure type of neurological decit recovery imaging
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Migraine Aura
99% 31%
18%
n=163
Michael B. R. et al. Brain 1996: 119, 355-361
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Hemiplegic migraine
Description
I was reported that a young aged man came into the hospital because transient weakness of his right side of the body
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hemorrhage into tumor obstructive hydrocephalus secondary effect from of mass or edema on cerebral vasculature
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Toxic/Metabolic-???
Hypoglycemia and focal paresis -a case description
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Functional hemiparesis
Conversion disorder is the most
commonly assigned psychiatric disorder presentations of conversion disorder noted that symptoms of paresis, paralysis, or movement disorders were common and were a presentation in almost 30% of patients.
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Point...
Not all stroke patient come with sudden neurological decit Strokes
with
atypical
presentations
that
take
on
the
appearance
of
other
disease
process
stroke cameleons
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Stroke chameleons
what is common...hemiparesis, sensory loss, ataxia, language disorder, visual loss, vertigo what is uncommon...
Saturday, May 11, 2013
uncommon manifestation: movement disorder, behavior abnormality, pain, isolated memory loss.. etc uncommon time-course...slow progressive, uctuation
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Cardiac embolism
Atherosclerosis
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TOAST classication
Large-artery atherosclerosis(emboli/ thrombosis) Cardioembolism(high-risk/mediumrisk) Small-vessel occlusion(lacune) Stroke of other determine etiology Stroke of undetermined etiology
Infection and stroke Drug abuse and stroke Stroke and systemic vasculitis migraine and stroke Fibromuscular dysplasia Hypercoagulable state
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Clinical clues
Stroke in the young No atherosclerotic risk Underlying of particular disease; SLE,
AIDS, carcinoma, migraine
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Show case
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55 Y.O. woman presented with subacute headache and then weakness of right arm
CT Brain non-contrast
lling hyperdense along superior sagittal sinus Dx. Superior sagittal vein thrombosis
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Saturday, May 11, 2013
may be uni-or bilateral not distribute along artery territory may associated with hemorrhage tend to be subcortical clot along venous system
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Underlying
Cholangio carcinoma
Dx. stroke due to
hypercoagulable state
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A 41 Y.O. woman presented with proximal muscle weakness and generalized hyperreexia
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A 24 Y.O. Thai lady presented was admitted to the hospital because of an acute left arm and leg weakness for 1 day Underlying SLE Dx. multiple intracranial hemorrhage
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Other cause
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String sign
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etiology
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HIV vasculopathy
Computed tomography cerebral angiography demonstrating multifocal stenoses (arrows) of the left middle cerebral artery (MCA) in a HIV positive patient with stroke.
Digital subtraction angiogram demonstrating fusiform dilatation of the right second portion of the posterior cerebral artery
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