Table 1.

Diagnostic modelling in neurology based on the temporal course of symptom onset

Time courseOnset timeProbable aetiology
HyperacuteSeconds• Vascular eg stroke
• Epileptic seizure
AcuteMinutes• Vascular
• Toxic-metabolic
• Compressive lesions
• Vasovagal syncope
SubacuteOver 72 hours• Toxic-metabolic eg B12 deficiency
• Inflammation (Infective or immune-mediated)
• Closed space pathology eg subdural haemorrhage
• Infiltrative or neoplastic process
• Myasthenia gravis
• Medical decompensation of previous neurological insult (can occur with or without delirium)
Remitting –RelapsingBack to baseline within a day• transient ischemic attack (usually recovered in <1 hour)
• Periodic disorders (migraine with aura, epilepsy, ocular myasthenia)
Remitting –RelapsingReturning to baseline but taking days–weeks• Multiple sclerosis
• Toxic-metabolic eg drug toxicity
StutteringUsually acute or subacute in onset but patient developing new deficits rather than progression of existing ones• Stroke-like syndromes due to vasculitis/endocarditis
• Autoimmune encephalitis
• Myasthenia and atypical forms of Guillain-Barré syndrome
Chronic, progressiveWeeks• Guillain-Barré syndrome
• Malignancy
Chronic, progressiveMonths• Degenerative diseases eg Alzheimer's disease, motor neurone disease
• Malignancy
  • Common diseases may present in an atypical manner