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My name is Daniel Walzman. I am a neurosurgeon at Northern New Jersey and currently work with North Jersey Brain and Spine Center. And I also serve as chief of Endovascular Neurosurgery at Hackensack University Medical Center.Depending on what part of the brain is suffering the lack of blood flow you will have different symptoms. In general, any ischemic stroke is going to manifest by a new onset of neurological deficit. For example, if you occlude the right MCA then people will typically have slurred speech but be able to speak and have weakness on the left side of the body. If you occlude the left MCA people will typically not be able to speak meaning they will not be able to find words to even say, they often will not be able to understand speech so if you tell them raise your right arm they will not understand what you are saying. They will hear you but they will not understand what you are saying. They will typically have right side weakness with that as well.Hemorrhagic strokes however really present different clinical presentations as well, with the ruptured aneurysm really presenting the classic worst headache of your life. And the intracranial hemorrhages more typically presenting with the severe headache, associated with the neurological deficit like an ischemic stroke. So often times, when the patient is presenting with a new neurological deficit most of the time, the differential diagnosis  really is between a hemorrhagic stroke or an ischemic stroke. With ischemic stroke being more frequent. Whereas subarachnoid hemorrhage caused by a ruptured aneurysm more often has a much more distinct presentation of sudden onset of severe headache sometimes with altered mental status but is more of a global dysfunction rather than a focal dysfunction.
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