Stroke Mimics in a Brazilian Stroke Center: a Retrospective Cohort in a Brazilian Stroke Unit

Abstract

Background: stroke is a highly common neurologic disease, with great mortality and morbidity rates. It is a cerebrovascular condition characterized by a deficiency in the blood supply that should reach the nervous tissue. It can be classified into two types, depending on its etiology: ischemic and hemorrhagic stroke, the first one being the most common. The correct diagnosis of this condition is a challenge, especially in cases of confusing conditions, such as stroke mimics (SM). A highly detailed epidemiologic description and previous knowledge of the disease can help to recognize it. In cases of stroke, a quick revascularization treatment is necessary for a good clinical outcome, however, the inadvertent administration of thrombolytics to the patient with SM can cause hemorrhage and death, as well as unnecessary costs. The present study consisted in evaluating the patients admitted in the stroke unit of the Clinical Hospital Complex of the Federal University of Paraná in Brazil, between October 2012 and September 2013, and describing the prevalence, clinical presentation, etiology, and treatment outcomes in the SM cases primarily diagnosed as a stroke. Results: 10 patients (7.1%) of the total number of patients with less than four hours of symptoms onset were considered SM and six were submitted to intravenous thrombolysis. The main clinical presentations were motor symptoms (90%) and dysarthria and sensitive symptoms (60%). Regarding the etiology of the patients with SM, six patients (60%) had functional disorders, one (10%) had Todd paresis, one (10%) exogenous intoxication, one (10%) diabetic ketoacidosis, and one (10%) presented with a clinically isolated syndrome. Conclusions: our results showed that an important percentage of patients admitted to a stroke unit are SM and that a significant part of these SM is subjected to unnecessary thrombolytic procedures. Thus, further studies are necessary and important to develop well-defined guidelines that stratify the risk of SM and evaluate, based on the stratification, the risk-benefit of soliciting imaging methods that can help to distinguish between stroke and SM.