Symptom spread to contiguous body parts as a presentation of cerebral ischemia

BACKGROUND: Ischemic stroke commonly presents with sudden onset of focal deficit that is maximal at onset. Symptom onset marked by the spread of symptoms to contiguous body parts may suggest migraine, seizure or cerebral amyloid angiopathy (CAA) that is mimicking ischemic symptoms. OBJECTIVE: To assess (1) if the spread of symptoms to contiguous body parts is an uncommon presentation of ischemic stroke and transient ischemic attack (TIA) and (2) if patients presenting with this symptom complex frequently have migraine, seizure or CAA mimicking stroke or TIA. METHODS: 110 consecutive patients presenting with stroke-like symptoms were prospectively evaluated for symptoms at onset, abnormalities on cerebral imaging, risk factors for stroke, discharge diagnosis, and development of subsequent TIA/stroke, migraine, seizure, or cerebral hemorrhage during follow-up. RESULTS: Of patients able to give a history of symptoms at onset, 23% described symptoms spreading to contiguous body parts. None had a history of migraine or seizure. None had clinical course or imaging features typical of CAA. During follow-up, 1 was diagnosed with migrainous stroke and none had suffered seizure or intracranial hemorrhage. CONCLUSIONS: The spread of symptoms to contiguous body parts is not uncommon at the onset of ischemic TIA/stroke. In our series, migrainous stroke was much less common and none had evidence of seizure or CAA.