Central nervous system disorders

V./4.7.: Differential diagnosis

Some focal neurological signs may resemble TIA in migraine with aura. Aura without migraine could occur without headache that makes differential harder. Complicated migraine or familiar hemiplegic migraine may first diagnosed as stroke. Focal epileptic seizure could be accompanied with transient limb paresis, hemiparesis in the postconvulsive phase (Todd paresis). It may be difficult to diagnose as well.

Generally, intracranial tumors are easily differentiated based on history and clinical course. Ictal symptoms can be caused by tumor haemorrhage. Thrombosis of the cerebral sinuses and veins generally cause progressive symptoms, but sometimes rapidly progressing or ictal thrombosis of the sinuses may develop.

Hemisyndrome, such as hemiparesis may be caused by severe hypo- or hyperglycaemia.

Hypoxia of any cause (hypoxemia, anaemia, histotoxic) results in global damage of the brain, which does not follow vascular arterial territory. The most sensitive areas to hypoxia are the watershed zones and the frontal lobe followed by the hippocampus, parietal and occipital cortex, then the basal ganglia and the cerebellum. Brain stem is the least sensitive.

Arterial epidural and acut subdural (venous) bleeding after head trauma is characterized by anisocoria (wide, non-reactive to light pupil on the side of the lesion) and rapidly deepening unconsciousness.