MAJOR STROKE SYNDROMES AND STROKE MIMICS

The three main divisions of the brain are the cerebrum (including the left and right cerebral hemispheres), the brainstem, and the cerebellum. The signs of a patient with brain injury depend on where in the brain the lesion occurs. Differentiating a stroke from a stroke mimic is based on (1) history of symptom onset (e.g., stroke presents suddenly and with no associated trauma, brain tumors present over weeks to months, seizures present with shaking of a limb or a staring episode, hypoglycemia, often presents after excessive insulin use, subdural hematomas present after head trauma), (2) past medical history (e.g., stroke patients often have vascular risk factors such as hypertension or diabetes, brain tumor patients may have a history of systemic cancer, seizure and migraine patients usually have a history of similar episodes in the past), and (3) laboratory data (e.g., hypoglycemic patients have low blood glucose and computed tomography [CT] scan differentiates stroke from tumor, abscess, and intracranial hemorrhage). Thus, one cannot determine by neurologic examination alone whether an acute stroke is ischemic or hemorrhagic. Based on brain localization, the major stroke syndromes are:

1. Left Hemisphere
   
2. Right Hemisphere
   
3. Brainstem
   
4. Cerebellum
   
5. Possible Hemorrhage

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