Summary
Definition
History and exam
Key diagnostic factors
- patient/caregiver report of focal neurologic deficit
- sudden onset and brief duration of symptoms
Other diagnostic factors
- history of extracranial atherosclerosis
- history of cardiac disease
- unilateral symptoms
- increased BP on presentation
- focal neurologic deficit on exam
- absence of positive symptoms (shaking, scotoma, spasm)
- absence of headache
- history of migraine
- absence of seizure prior to neurologic 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)
- hyperlipidemia
- inactivity
- obesity
- hypercoagulability
Diagnostic investigations
1st investigations to order
- blood glucose
- chemistry profile
- CBC
- prothrombin time, INR, and activated PTT
- ECG
- brain MRI with diffusion
- fasting lipid profile
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
Treatment algorithm
Contributors
Authors

Associate Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
Disclosures
JS declares that she has no competing interests.
Assistant Professor
Department of Neurology
University of Colorado School of Medicine
Aurora
CO
Disclosures
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.
Disclosures
EC declares that he has no competing interests.
Peer reviewers
Staff Physician
Section of Geriatric Medicine
Cleveland Clinic
Cleveland
OH
Disclosures
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
London
UK
Disclosures
TR declares that he has no competing interests.
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