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Uncommon causes of ischaemic stroke: how to approach the diagnosis
  1. Robert Hurford1,
  2. Rekha Siripurapu2,
  3. Hedley C A Emsley3,
  4. Joanna Lovett4,
  5. David Werring5,
  6. Martin Martin Nicholas Punter6,7
  1. 1Neurology Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  2. 2Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3Lancaster Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
  4. 4Neurology Department, Wessex Neurological Centre, Southampton, UK
  5. 5Stroke Research Group, UCL institute of neurology, London, UK
  6. 6Department of Medicine, University of Otago, Wellington, New Zealand
  7. 7Department of Neurology, Wellington Regional Hospital, Newtown, New Zealand
  1. Correspondence to Dr Martin Martin Nicholas Punter, Department of Neurology, Wellington Regional Hospital, Wellington 6021, New Zealand; martin.punter{at}


Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic ‘red flags’ and propose a structured approach to investigating them.


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  • Twitter @martin_punter

  • Contributors RH, DW and MMNP conceived the concept. RH wrote the first draft. RS provided expert neuroradiology input. Other authors reviewed and critically appraised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed by Tom Hughes, Cardiff, UK.

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