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| Headache | Dizziness | Back Pain | Weakness | Seizure |
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| History | Patients use words like “migraine” and “sinus infection” that may mislead the physician.
Beware previous diagnoses; they might be wrong. | The use of the word “vertigo” versus other dizziness descriptors is not etiologically useful. | Patients use word “sciatica” which may lead physicians to diagnose sciatica. | Stroke patients may complain of “clumsiness” or “my arm felt like lead” rather than “weakness”. | Patient (or witness) says “seizure” after a faint
Seizure patients often present after the seizure with only an altered mental status or with a postictal “Todd’s” paralysis |
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| Physical exam | Patients with SAH may be well appearing and neurologically intact. | Patients with small posterior circulation strokes can mimic a peripheral vestibular presentation. | Patients with serious causes of back pain can present without neurological deficits. | Patients with stroke can present with just about any focal deficit depending upon the occluded vessel. Myasthenia patients’ symptoms wax and wane.
GBS patients’ first symptoms may be purely sensory. | Patients may be lethargic, but neurologically intact. |
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| Diagnostic testing | For SAH, CT sensitivity is good but decays with time.
CT has poor sensitivity for CVST and dissection. | CT is a poor test for cerebellar and brainstem infarction | No MRI available
MRI must target the correct segment(s) of the spine. | False normal CT in early stroke | EEG often not available in the emergency department. Not performing LP in seizure patients who may have encephalitis or neurocysticercosis. |
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| Preconceived notions | Headache improved with triptans so is not a serious secondary cause. | Posterior circulation strokes are obvious or devastating events | All patients with SEA have risk factors or fever, or neurological deficits | Young people do not get strokes | Seizures (or seizure-like movements) are sometimes seen with strokes.
Convulsive movements are common in syncope. |
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