• TIA (Transient ischemic attack)
  • Stroke (hemorrhagic vs. ischemic, see the next 4)
  • Ischemic Stroke
  • Subdural hemorrhage /hematoma
  • Intracerebral hemorrhage – can occur rapidly and cause focal neurologic symptoms.
  • Subarachnoid hemorrhage.
  • Seizures and postictal deficits e.g. Focal Seizures; Generalized seizures
  • Postictal paresis/paralysis (Todd’s palsy) after a seizure. This is a focal weakness in a part of the body after a seizure.
  • Migraines with auras) / Complicated migraine headaches
  • Syncope / Presyncope
  • Vertigo or dizziness
  • Multiple sclerosis
  • Cervicogenic headache / Cervicalgia headache
  • Benign headache
  • Head trauma
  • Labyrinthitis
  • Vestibular neuritis
  • Other peripheral vestibulopathy
  • Systemic infection
  • CNS infection
  • Benign Positional Vertigo.
  • Hypotension
  • Brain tumor* / Cancer
  • Conversion disorder; Somatization disorder
  • Panic attack
  • Malingering
  • Hypoglycemia
  • Hyperglycemia
  • Hyponatremia
  • Drug or alcohol intoxication
  • Hyperosmolar Hyperglycemic State (HHS)*
  • Delirium (also called Acute confusional state) –
  • Hypertensive encephalopathy
  • Transient episodic dizziness caused by peripheral vestibulopathy
  • Nerve or nerve root compression*
  • Peripheral neuropathy
  • Guilain Barre’
  • Hepatic encephalopathy,
  • Renal encephalopathy; Acute renal failure
  • Pulmonary encephalopathies
  • Other toxic or metabolic encephalopathy
  • Wernicke encephalopathy
  • Transient global amnesia
  • Cerebral amyloid angiopathy
  • Systemic Infection (Viral, bacterial, etc)
  • Acute disseminated encephalomyelitis (ADEM)
  • Encephalitis
  • Brain abscesses
  • Dementia
  • Headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL) syndrome
  • Spinal epidural hematoma
  • Aortic dissection
  • Compressive myelopathy
  • Spinal dural arteriovenous fistulas

 

The differential above can easily be derived by working through the VINDICATED MEN mnemonic

Explanations of differential diagnosis

  • Brain tumor * – Hemorrhage into a tumor can cause abrupt focal symptoms that appear like a stroke. Also, some tumors which are outside the brain (eg, meningiomas) reach a critical mass and can cause abrupt displacement of brain tissue with the sudden onset of symptoms.
  • Hyperosmolar Hyperglycemic State (HHS)* – Nonketotic hyperglycemic stupor is often associated with focal neurologic signs; there may be a focal region of brain edema on brain imaging tests.
  • Nerve or nerve root compression* – Transient paresthesia and numbness caused by pressure-or position-related peripheral nerve or nerve root compression.

 

Further Reading

Eur J Radiol. 2017 Nov;96:133-144. Acute stroke differential diagnosis: Stroke mimics. https://www.ncbi.nlm.nih.gov/pubmed/28551302

Am Fam Physician. 2015 Apr 15;91(8):528-536. https://www.aafp.org/afp/2015/0415/p528.html

https://www.uptodate.com/contents/differential-diagnosis-of-transient-ischemic-attack-and-stroke

https://emedicine.medscape.com/article/1916852-differential

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