Diagnosis of acute stroke. How to relate presentation to vascular anatomy

Stroke is a heterogeneous disease with many different causes and presentations. Ischemic strokes can be due to occlusion of large or small vessels by thrombi or emboli. Hemorrhagic strokes are due to rupture of small vessels within the brain or rupture of aneurysms at the base of the brain. An understanding of the vascular anatomy of stroke syndromes is essential to planning an efficient evaluation. The workup should be individualized for each patient and should rule out processes that can produce strokelike syndromes. Despite the availability of advanced imaging tools, the clinical evaluation is still of paramount importance.