Ischemic stroke occurs when a blood vessel supplying the brain is obstructed.
Consider stroke in any patient presenting with sudden focal neurological deficit or any alteration in level of consciousness.
Rapid evaluation is essential for sure of time-sensitive treatments.
Determine if patient's symptoms are due to stroke and exclude stroke mimics (eg migraine, hypertensive encephalopathy, hypoglycemia, seizures or post-ictal paresis); identify other conditions requiring immediate intervention and determine the potential causes of stroke.

Differential Diagnosis

  • Exclude stroke mimics or conditions with strokelike symptoms that include migraine, hypertensive encephalopathy, hypoglycemia, seizures or post-ictal paresis

Bell's Palsy
Benign Paroxysmal Positional Vertigo (BPPV)
Hypertensive Encephalopathy

  • Presents with significant hypertension, headache, delirium and cerebral edema
Intracerebral Hemorrhage (ICH)
  • Please see Intracerebral Hemorrhage Disease Management Chart 

Intracranial Mass

  • Eg tumor, abscess
  • Differentiated by CT scan or MRI scan; defined by gradual onset of symptoms; may present with stroke-like deterioration
Metabolic Disorders, Metabolic Encephalopathy
  • Hypoglycemia may present with stroke-like symptoms


  • Neurologic symptoms usually have a gradual onset; migrainous aura may be confused with stroke or transient ischemic attack
Peripheral Nerve Disorders

  • Present with a pattern of distribution of symptoms


  • Post-seizure patients can present with unilateral weakness (Todd’s paralysis)
  • Neurologic symptoms are usually positive rather than losing function

Syncope and Transient Global Amnesia
Transient Ischemic Attack (TIA)

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
4 days ago
The appropriate cutoff value in predicting combined cardiovascular outcomes in patients with type 2 diabetes (T2D) is 125 mm Hg for home morning systolic blood pressure (MSBP), suggests a new study.
Pearl Toh, 3 days ago
Whether the 2017 ACC/AHA* blood pressure (BP) guidelines should be adopted in Asian countries was the topic of a much-anticipated discussion here at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taiwan last week.
Jairia Dela Cruz, 5 days ago
Rheumatoid arthritis patients who use low-dose aspirin in primary prevention of cardiovascular (CV) disease have similar risks of major toxicity and CV events as those who are not exposed to aspirin, according to a secondary analysis of the PRECISION* trial.
15 May 2018

A study by researchers at Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) found that, even at levels currently considered normal, low-density lipoprotein cholesterol (LDL-C) is a prime predictor of the presence of atherosclerotic plaques in arteries. [J Am Coll Cardiol 2017;70:2979–2991]