Mimics and chameleons in stroke

Abstract

Ischaemic stroke is a treatable medical emergency. In an era of time-dependent reperfusion techniques, it is crucial that an accurate and prompt diagnosis is made. Approximately 30% of patients admitted to hyperacute stroke units are subsequently found not to have a fi nal diagnosis of acute stroke although some of these patients do have incidental or previously symptomatic cerebrovascular disease. These patients do not benefi t from thrombolysis and may require the input of other specialists or treatments. Meanwhile, a proportion of patients with acute stroke have unusual presentations and are sometimes initially admitted to general medical admissions units prior to accessing stroke unit care. It is important that atypical presentations of stroke are recognised so that patients are not denied the benefi ts of stroke unit care and secondary prevention. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging.

Stroke and TIA mimics in patients referred to a neurological emergency department by non-ambulance physicians, ambulance physicians and paramedics.

“…Recent data shows that mimics may account for 2% to 47% of suspected strokes and up to 60% of suspected TIAs [2,7,9,11,19,28,29]. In our cohort, the overall proportion of ACE mimics was 32.2%, which is slightly lower than the 36.8% observed in our previous study [6].…”

“…Results from previous studies addressing the issue of ACE mimics are not uniform. The most frequent misdiagnoses have included seizures (7-21%), vertigo (2-5%), brain tumours (4-15%), metabolic and electrolyte disturbances (4-24%), infections (7-16%) and functional disorders (1-8%), which only partially overlap with our results (vertigo followed by metabolic and electrolyte disturbances, headache, seizures and brain tumours without any functional disorders) [10,11,[26][27][28][29][30][31].…”

'Stroke chameleons'

“…Острый вестибулярный синдром (вертиго, тошнота, рвота, непереносимость движений головой, нистагм и атаксия) чаще возникает в рамках периферических вестибулопатий. Для ОИ в бассейне задней циркуляции характерно наличие синдрома «головокружение плюс», когда наряду с вертиго имеются дополнительные очаговые симптомы (мозжечковая атаксия, моторный и/или сенсорный дефицит, поражение краниальных нервов) [3,5]. Однако в исследовании H. Lee и соавт.…”

“…бенно при наличии факторов сердечно-сосудистого риска [2][3][4][5]. J. Huff [2] разделил все возможные клинические сценарии на четыре группы:…”

Toxidrome sedante versus enfermedad cerebrovascular: a propósito de un caso

“…Refieren que la paciente ha manifestado ideas de muerte y en la última semana presentó problemas familiares. alteracion del estado de conciencia, tener en cuenta, estudiar y descartar el accidente cerebrovascular (ACV) isquémico, ya que esta condición está descrita como uno de los principales síntomas camaleónicos, que son aquellas condiciones en donde un ACV puede simular una patología alternativa 16,17 . De los pacientes que ingresan con alteracion en el estado de conciencia sin evidencia de focalización, hasta en el 70% de los casos el diagnóstico de ACV no se realiza de forma correcta 18 .…”