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)

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