Last reviewed:December 2019
Last updated:October  2019



History and exam

Key diagnostic factors

  • patient/carer report of focal neurological deficit
  • brief duration of symptoms

Other diagnostic factors

  • history of extracranial atherosclerosis
  • history of cardiac disease
  • unilateral symptoms
  • increased BP on presentation
  • focal neurological deficit on examination
  • absence of positive symptoms (shaking, scotoma, spasm)
  • absence of headache
  • history of migraine
  • absence of seizure prior to neurological deficit
  • no history of epilepsy
  • family or personal history of premature stroke, miscarriage, or venous thromboembolism
  • carotid bruit

Risk factors

  • atrial fibrillation
  • valvular disease
  • carotid stenosis
  • congestive heart failure
  • hypertension
  • diabetes mellitus
  • cigarette smoking
  • alcohol abuse
  • advanced age
  • patent foramen ovale (PFO)
  • hyperlipidaemia
  • inactivity
  • obesity
  • hypercoagulability

Diagnostic investigations

1st investigations to order

  • blood glucose
  • chemistry profile
  • FBC
  • prothrombin time, INR, and activated PTT
  • ECG
  • brain MRI with diffusion
  • fasting lipid profile
Full details

Investigations to consider

  • head CT
  • ESR
  • telemetry/Holter monitor
  • echocardiogram with bubble study
  • carotid Doppler ultrasound
  • CT angiography
  • magnetic resonance angiography
  • transcranial Doppler
  • hypercoagulability studies
Full details

Treatment algorithm


Jennifer Simpson

Associate Professor

Department of Neurology

University of Colorado School of Medicine




JS declares that she has no competing interests.

Assistant Professor

Department of Neurology

University of Colorado School of Medicine




KO is Site Principal Investigator for Amplatzer - PFO Post Approval Study; KO is also a member of the CureCADASIL Advisory Board.

Dr Jennifer Simpson and Dr Karen Orjuela wish to gratefully acknowledge Dr Ethan Cumbler, a previous contributor to this topic.

Peer reviewersVIEW ALL

Staff Physician

Section of Geriatric Medicine

Cleveland Clinic




RF declares that he has no competing interests.

Stroke Physician

Guy's and St Thomas' NHS Foundation Trust

Stroke Programme Director

Royal College of Physicians




TR declares that he has no competing interests.

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