Stroke Mimics

Magauran, Brendan; Nitka, Meaghan V.

doi:10.1016/j.emc.2012.06.006

Cited by 24 publications

(11 citation statements)

References 61 publications

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“…The proportion of SMs among suspected strokes differs considerably from medical research [2] cited as 19% [3], 14% [4] and 13% [5]. According to the published literature, forecasters of SMs are younger individuals, more frequently females, with fewer risk factors for stroke [6] than real stroke cases.…”

Section: Introductionmentioning

confidence: 91%

Clinical Characteristics of Stroke Mimics Presenting to a Stroke Center within the Therapeutic Window of Thrombolysis

Yahia

Bashir

2018

Brain Neurorehabil

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Highlights• Stroke mimics (SMs) represents 15.9% of all suspected strokes.• Some characteristics differentiate SMs among suspected strokes.• Commonest mimics in order: psychiatric disorders, migraines, and seizures. ABSTRACTThis study aimed at identifying the frequency and final diagnoses of stroke mimics (SMs) among suspected stroke cases, and seeking differences in clinical & imaging features between SMs and true strokes. It was retrospective with data taken from an ongoing stroke registry for patients admitted to a Stroke Unit between 1 May and 31 October 2011. Baseline characteristics, clinical & imaging features, complications, and outcomes of SMs were compared to those with true strokes by appropriate statistical tests. The total number of cases admitted was 537. Only 232 (43.2%) of them presented during the critical time thrombolytic intervention. SMs comprised 15.9% of all suspected stroke cases. The commonest mimics were psychiatric disorders (43.2%), migraines (16.2%), seizures (8.1%), brain tumors (5.4%), and systemic infections (5.4%). SMs were younger, more common in females, with less evidence of preexisting hypertension (43.2% vs. 56.9% for true strokes). Hemianopia (p = 0.001), sensory inattention, neglect or both (p < 0.001) were more associated with true strokes, while cerebellar, brainstem signs or both (p = 0.045) excluding dysarthria were linked only to SMs. Acute ischemic signs in imaging scans were found linked to true strokes. Some clinical and imaging characteristics were found to differentiate to some extent between SMs and true strokes.

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Section: Introductionmentioning

confidence: 91%

Clinical Characteristics of Stroke Mimics Presenting to a Stroke Center within the Therapeutic Window of Thrombolysis

Yahia

Bashir

2018

Brain Neurorehabil

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“…Die höchsten SM-Raten mit 40-50 % werden für die präklinischen Diagnosestellungen berichtet, während die mittlere SM-Fehldiagnoserate in den Notaufnahmen mit 25 % in etwa halb so hoch ist [21]- [25]. Die Schwankungsbreite der SC-Rate ist mit 2-31 % enorm hoch [26] [27]. Grund dafür ist die Abhängigkeit der SC-Rate von der methodischen Qualität der Analyse von übersehenen Schlaganfällen [4].…”

Section: Präklinische Situation Und Notaufnahmeunclassified

Stroke Mimics und Stroke Chamäleons – Differenzialdiagnose des Schlaganfalls

Erbguth¹

2017

Fortschr Neurol Psychiatr

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The analysis of misdiagnosis of stroke has become increasingly relevant because of the time pressure in the thrombolytic treatment of ischemic strokes. Within the narrow time window of thrombolysis, a false-positive stroke diagnosis can lead to a faulty and potentially dangerous thrombolysis. The terms "Stroke Mimic" (SM = false-positive stroke diagnosis) and "Stroke Chameleon" (SC = false-negative stroke diagnosis) have been introduced for misdiagnosis in this field. The rate of SM decreases during the treatment phases from approximately 50 % in the preclinical situation to approximately 2-10 % in the Stroke Unit indicating thrombolytic therapy. The complication rate for not indicated thrombolysis in SM is low with 0.5 % for intracranial bleeding and 0.3 % for orolingual edema. Thus, the net balance in favour of fast thrombolysis is maintained, even when a higher number of mis-indicated lyses occurs in SM. The rate of SC during the stages of treatment drops from about 50 % in the preclinical stage to about 2-5 % in stroke units. The rates of SM and SC are inversely linked: a reduction in the SM rate leads to a more critical diagnosis of stroke, thus increasing the number of underdiagnosed stroke cases as SC, and vice versa. While SM rarely lead to the legal consequences of treatment error, SC often give rise to accusations of medical errors.

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“…Stroke mimics is a term indicating a pathological condition that shows a stroke‐like clinical picture due to a symptom caused by a disease other than cerebrovascular diseases 6. The causes of stroke mimics are diverse and are mainly metabolic, such as hypoglycemia, hepatic encephalopathy, and neurological diseases, such as encephalitis and brain tumor 7.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of stroke mimics in the emergency department

Okano

Ishimatsu

Kato

et al. 2018

Acute Medicine & Surgery

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AimTo clarify the features of stroke mimics.MethodsWe retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue‐type plasminogen activator treatment time window.ResultsOf 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20.4%), neuropathy‐like symptoms (21 cases, 15.3%), and hypoglycemia (15 cases, 10.9%). Outcomes were survival to hospital discharge for 91.2% and death for 8.8% of the cases. Clinical results were significantly different between stroke mimics and the stroke group for low systolic blood pressure, low National Institutes of Health Stroke Scale score on initial treatment, history of diabetes, and no history of arrhythmia. On multivariate analysis, distinguishing factors for stroke mimics include systolic blood pressure ≤ 140 mmHg, National Institutes of Health Stroke Scale score ≤ 5 points, history of diabetes, and no history of arrhythmia.ConclusionsFrequency of stroke mimics in cases of acute stroke suspected cases is 8.8%, and the most common cause is epilepsy. In order to distinguish stroke mimics, it is useful to understand common diseases presenting as stroke mimics and evaluate clinical features different from stroke by medical interview or nerve examination.

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Stroke Mimics

Cited by 24 publications

References 61 publications

Clinical Characteristics of Stroke Mimics Presenting to a Stroke Center within the Therapeutic Window of Thrombolysis

Clinical Characteristics of Stroke Mimics Presenting to a Stroke Center within the Therapeutic Window of Thrombolysis

Stroke Mimics und Stroke Chamäleons – Differenzialdiagnose des Schlaganfalls

Clinical features of stroke mimics in the emergency department

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