Variables That Best Differentiate In-Patient Acute Stroke from Stroke-Mimics with Acute Neurological Deficits

Abstract

Introduction. Strokes and stroke-mimics have been extensively studied in the emergency department setting. Although in-hospital strokes are less studied in comparison to strokes in the emergency department, they are a source of significant direct and indirect costs. Differentiating in-hospital strokes from stroke-mimics is important. Thus, our study aimed to identify variables that can differentiate in-hospital strokes from stroke-mimics. Methods. We present here a retrospective analysis of 93 patients over a one-year period (2009 to 2010), who were evaluated for a concern of in-hospital strokes. Results. About two-thirds (57) of these patients were determined to have a stroke, and the remaining (36) were stroke-mimics. Patients with in-hospital strokes were more likely to be obese (p = 0.03), have been admitted to the cardiology service (p = 0.01), have atrial fibrillation (p = 0.03), have a weak hand or hemiparesis (p = 0.03), and have a prior history of stroke (p = 0.05), whereas, when the consults were called for “altered mental status” but no other deficits (p < 0.0001), it is likely a stroke-mimic. Conclusion. This study demonstrates that in-hospital strokes are a common occurrence, and knowing the variables can aid in their timely diagnosis and treatment.

“Encephalopathy Only Stroke Codes” (EoSC) Rarely Result in Stroke as Final Diagnosis

“…These differences were not found in true stroke (EoSC CVA+) patients. We found diabetes to be the only significant factor to predict stroke within the EoSC CVA+ cohort (using Definition 2) but did not find the expected correlation with AFib or cardiac history [8]. These findings may be due to the resultant small eventual sample size of EoSC diagnosed CVA+ patients.…”

Acute Ischemic Stroke Management Review for the Hospitalist

“…The use of the NIHSS may help exclude stroke mimics (39). Several studies show that alternate diagnoses are found in 22 to 38% of suspected stroke cases (40)(41)(42). It is essential to distinguish stroke from notable mimics since rtPA administration not only exposes the patient Haldal et al…”

“…Notable stroke mimics include seizure, encephalopathy, syncope, migraine, sepsis, and toxic/ metabolic derangements (42). Compared to mimics, stroke is more likely if a patient has almost any focal neurological symptom, such as subjective hand weakness or objective hemiparesis (42).…”

“…Notable stroke mimics include seizure, encephalopathy, syncope, migraine, sepsis, and toxic/ metabolic derangements (42). Compared to mimics, stroke is more likely if a patient has almost any focal neurological symptom, such as subjective hand weakness or objective hemiparesis (42). Stroke is also more common with a normal mental status, NIHSS 1b score of 0, admission to a cardiology service, atrial fibrillation at the time of onset or during hospitalization, history of prior stroke and obesity (40,42,44).…”

“…Stroke is also more common with a normal mental status, NIHSS 1b score of 0, admission to a cardiology service, atrial fibrillation at the time of onset or during hospitalization, history of prior stroke and obesity (40,42,44). In contrast, increased likelihood of a stroke mimic is seen with patients exhibiting objective confusion, known history of cognitive impairment, loss of consciousness, seizure at onset, retained ability to walk, and absence of lateralizing symptoms (40,42,44). In-hospital stroke alerts are typically activated by nurses or physicians when a patient's neurological status acutely changes from his/ her baseline.…”