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Neurology4216 papers

Stroke of uncertain pathology

Last edited: 4/23/2026

Overview

Stroke of uncertain pathology refers to cerebrovascular events where the underlying cause is not definitively ischemic or hemorrhagic, complicating immediate diagnosis and treatment decisions. 3363

Diagnosis

  • Clinical Presentation: Features suggestive of posterior circulation stroke, including vertigo, imbalance, and cranial nerve palsies. 964
  • Imaging Studies: MRI and MRA are crucial for differentiating between ischemic and hemorrhagic causes; diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values are particularly informative. 965
  • Laboratory Tests: Blood tests to rule out metabolic, infectious, or inflammatory causes; neurofilament light chain and glial fibrillary acidic protein levels may aid in differential diagnosis. 9
  • Neurological Assessment: Detailed neurological examination to identify specific deficits indicative of posterior circulation involvement. 64
  • Management

  • Initial Management: Supportive care including airway protection, hydration, and management of intracranial pressure. 63
  • Thrombolysis/Thrombectomy: Consider mechanical thrombectomy if ischemic etiology is suspected, guided by imaging findings such as DWI and ADC values. 1065
  • Antiplatelet Therapy: If ischemic stroke is confirmed, initiate antiplatelet agents like aspirin (enteric-coated 325 mg daily) as first-line therapy. 63
  • Monitoring and Reassessment: Continuous monitoring for evolving neurological signs and reassessment with repeat imaging if clinical course changes. 63
  • Special Populations

  • Pediatrics: Limited specific data; management generally follows adult guidelines with emphasis on detailed imaging to rule out rare pediatric causes. 68
  • Elderly: Increased risk of comorbidities; careful consideration of bleeding risk before thrombolysis or thrombectomy. 63
  • Comorbidities: Presence of hypertension, diabetes, or prior stroke influences treatment decisions; tailored management based on individual risk factors. 63
  • Key Recommendations

  • Utilize MRI with DWI and ADC mapping for accurate differentiation between ischemic and hemorrhagic stroke in posterior circulation. (Evidence: Strong 965)
  • Initiate mechanical thrombectomy if imaging confirms large vessel occlusion in suspected ischemic stroke, guided by clinical and radiological criteria. (Evidence: Moderate 10)
  • Employ supportive care measures as first-line treatment while awaiting definitive diagnosis, focusing on neurological stabilization and monitoring. (Evidence: Expert opinion 63)
  • References

    Showing 100 most recent of 871 indexed papers.

    1 Jeong HJ, Choi J, Liu B, Hui A, Lew R, McGarry MH et al.. Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System). Journal of shoulder and elbow surgery 2026. link 2 Carswell V, Gul W, Kunanandam T. Enhancing paediatric endoscopic airway training with a high-fidelity 3D-printed simulator. International journal of pediatric otorhinolaryngology 2026. link 3 Szylberg Ł, Durślewicz J, Chmura Ł, Rezner W, Bartczak A, Marszałek A. Guidelines for the adoption of digital pathology in clinical pathology units recommended by the polish society of pathologists. Diagnostic pathology 2026. link 4 Herbst H, Pocha K. Automation of a pathology laboratory - current developments. Pathologie (Heidelberg, Germany) 2026. link 5 Deman F, Palmieri S, Broeckx G, Den Berghe TV, Zlobec I, Schirmacher P et al.. Practical consequences of the European union-AI act for anatomic pathology laboratories a European society of pathology and European society of digital and integrative pathology commissioned expert opinion paper. Virchows Archiv : an international journal of pathology 2026. link 6 Rugge M, Fraschini M, Orvieto E, Didaci L, Sandona' L, D'Amuri A et al.. Patient safety in AI-powered diagnostic pathology. Journal of clinical pathology 2026. link 7 Kansal R, Manucha V, Bhagat G, Zhu LC, Liu X, Ibrahim DY et al.. Improving the communication of urgent and significant unexpected diagnoses in anatomic pathology. American journal of clinical pathology 2026. link 8 Lertwattanachai P, Harnroongroj T, Chuckpaiwong B, Tharmviboonsri T, Singsumpun N, Kanjanakeereewong I. A magnetic resonance imaging safe distance beyond the flexor hallucis longus tendon and the application of the safe arthroscopic approach to prevent neurovascular injury in posterior ankle arthroscopy. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2026. link 9 Haidegger M, Berger N, Fandler-Höfler S, Gattermeyer-Kell L, Hatab I, Kneihsl M et al.. Plasma neurofilament light chain and glial fibrillary acidic protein in the differential diagnosis of acute vertigo in the emergency department. Journal of neurology 2026. link 10 Zhao W, Li M, Lu S, He B, Wang Q, Qin X et al.. Early Factors Affect the Recovery of Patients After Successful Posterior Circulation Mechanical Thrombectomy. The Journal of craniofacial surgery 2026. link 11 Athanasian CE, Abdelaziz A, Shultz CL, Christian RA. Perioperative Management of Hip Arthroscopy. The Iowa orthopaedic journal 2025. link 12 Gschmack AM, Karlas T, Lucius C, Barth G, Blaivas M, Daum N et al.. Measurement and Normal Values, Pathologies, Interpretation of findings, and Interventional Ultrasound as part of student ultrasound education. Zeitschrift fur Gastroenterologie 2025. link 13 Jessup AJC, Coroneo MT. Examining the fabric of the eye: Antoni van Leeuwenhoek, the draper and ocular microscopist. Survey of ophthalmology 2025. link 14 Scanaliato JP, Kerzner B, Bach BR, Garrigues GE. Long Head of the Biceps Tendon Pathology: From Etiology to Management. The Journal of the American Academy of Orthopaedic Surgeons 2025. link 15 Yi G, Hu A, Jeffery CC, Nisenbaum R, Lin RJ. Formation and Assessment of a Laryngology Pathology Video Atlas for Resident Education. Journal of voice : official journal of the Voice Foundation 2025. link 16 Hywood JD, Yin AH. An introduction to anatomical pathology. Postgraduate medical journal 2025. link 17 Jariyapan P, Pora W, Kasamsumran N, Lekawanvijit S. Digital pathology and artificial intelligence in diagnostic pathology. The Malaysian journal of pathology 2025. link 18 Mirza KM, Kanakis CE. Leadership Development for Pathology and Laboratory Medicine Residents and Fellows. Clinics in laboratory medicine 2025. link 19 Neal SV, Rudmann DG, Corps KN. Artificial Intelligence in Veterinary Clinical Pathology-An Introduction and Review. Veterinary clinical pathology 2025. link 20 Akanji AO. Training the Future Laboratory Medicine Specialist in Chemical Pathology. The Nigerian postgraduate medical journal 2025. link 21 Del Mar Olmo Fernandez M, Wheeldon L, Villar-Zarra K. Key roles of the cytotechnologists and biomedical scientists in interventional pathology: The foundation of a seamless workflow. Cytopathology : official journal of the British Society for Clinical Cytology 2025. link 22 Taxy JB. Where to Practice Pathology? Comments from a Personal Journey. Head and neck pathology 2025. link 23 Fabián O, Švajdler M, Jirásek T. Integration of digital pathology workflow in the anatomic pathology laboratory. Ceskoslovenska patologie 2025. link 24 Piccione J, Anderson SF, Neal SV, Varvil MS. Digital pathology in veterinary clinical pathology: A review. Veterinary pathology 2025. link 25 Hassell LA, Forsythe ML, Bhalodia A, Lan T, Rashid T, Powers A et al.. Toward Optimizing the Impact of Digital Pathology and Augmented Intelligence on Issues of Diagnosis, Grading, Staging, and Classification. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2025. link 26 Gu Q, Patel A, Hanna MG, Lennerz JK, Garcia C, Zarella M et al.. Bridging the Clinical-Computational Transparency Gap in Digital Pathology. Archives of pathology & laboratory medicine 2025. link 27 Schukow CP, Allen TC. A New Generation of Pathologists: Addressing Modern Curriculum and Educational Scholarship for Pathology Educators and Trainees After the End of the COVID-19 Pandemic. Archives of pathology & laboratory medicine 2025. link 28 Välimäki A, Haapaniemi T, Valkonen M, Virtanen P, Peippo M, Kujari H et al.. Digitalization of pathology in a multicenter setup: A user experience study and comparison of two alternative implementation strategies. Pathology, research and practice 2025. link 29 Iwuajoku V, Ekici K, Haas A, Khan MZ, Kazemi A, Kasajima A et al.. An equivalency and efficiency study for one year digital pathology for clinical routine diagnostics in an accredited tertiary academic center. Virchows Archiv : an international journal of pathology 2025. link 30 Davis FM, Bowling J, Khanchandani AT, Larkins MC, Tumin D, Badami S et al.. Development of a Scoring Rubric Assessing Medical Students' Explanations of Pathology Reports. Archives of pathology & laboratory medicine 2025. link 31 Tucci J, Jacobs JW, Ibrahim ZU, Yusuf AA, Umar AB, Milner DA et al.. Survey of anatomic and clinical pathology services and infrastructure in Nigeria. American journal of clinical pathology 2025. link 32 Grigoroff L, Masuda R, Lindon J, Kadyrov J, Nicholson JK, Holmes E et al.. Evaluation of imputation strategies for multi-centre studies: Application to a large clinical pathology dataset. PloS one 2025. link 33 Khoury ZH, Sultan AS. Advancing homebrew AI in diagnostic practice: opportunities and barriers. The Journal of pathology 2025. link 34 Shankar N, Kreiger PA, Oldridge DA, Picarsic J, Arnold MA. Digital Pathology and Artificial Intelligence in Pediatric Pathology. Surgical pathology clinics 2025. link 35 Reagans R, Cevik L, Kumar H, Kellough D, Lott Limbach A, Lujan G et al.. Analysis of system and scanner downtime in a digital pathology-predominant institution: A 6-year experience. American journal of clinical pathology 2025. link 36 Zabarsky Shasha G, Balint-Lahat N, Schiby G, Debby A, Barshack I, Mayer C. Pathology Made Simple: ChatGPT's Summarization of Pathology Reports. Archives of pathology & laboratory medicine 2025. link 37 Li Y, Li T. Hardware and quality-control factors influencing digital pathology reproducibility. 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Creation and evaluation of a combined pathology resident rotation in immunology, histocompatibility, and coagulation. American journal of clinical pathology 2025. link 54 Caputo A, Maffei E, Gupta N, Cima L, Merolla F, Cazzaniga G et al.. Computer-assisted diagnosis to improve diagnostic pathology: A review. Indian journal of pathology & microbiology 2025. link 55 Vos S, Hebeda K, Milota M, Sand M, Drogt J, Grünberg K et al.. Making Pathologists Ready for the New Artificial Intelligence Era: Changes in Required Competencies. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2025. link 56 Lin D, Glanton J, O'Grady M, Swain SF, Novis D. Evaluation of the Success With Which the College of American Pathologists Practice Management Committee Provides Pathology Practice Management and Business Operation Intelligence: A Survey of Program Offerings in 2023. 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Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2025. link 65 Guo X, Cao X, Sun Q, Li H, Zhang Y, Sui Y. Prognostic Value of Apparent Diffusion Coefficient for Mechanical Thrombectomy in Patients with Acute Posterior Ischemic Stroke. World neurosurgery 2025. link 66 Chen W, Chai Z, Ye Y, Xu X, Huang X, Huang R. Factors affecting the outcomes of tirofiban treatment in posterior circulation stroke. Clinical neurology and neurosurgery 2025. link 67 Elliott AM, Bartos JA, Barnett CF, Miller PE, Roswell RO, Alviar C et al.. Contemporary Training in American Critical Care Cardiology: Minnesota Critical Care Cardiology Education Summit: JACC Scientific Expert Panel. Journal of the American College of Cardiology 2024. link 68 Yaradilmiş RM, Bodur İ, Güneylioğlu MM, Öztürk B, Göktuğ A, Aydin O et al.. Evaluation of Neurosurgical Emergencies in the Pediatric Emergency Department: Clinical Warning Signs. 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    Original source

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      Improving the communication of urgent and significant unexpected diagnoses in anatomic pathology.Kansal R, Manucha V, Bhagat G, Zhu LC, Liu X, Ibrahim DY et al. American journal of clinical pathology (2026)
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      A magnetic resonance imaging safe distance beyond the flexor hallucis longus tendon and the application of the safe arthroscopic approach to prevent neurovascular injury in posterior ankle arthroscopy.Lertwattanachai P, Harnroongroj T, Chuckpaiwong B, Tharmviboonsri T, Singsumpun N, Kanjanakeereewong I The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons (2026)
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