Lithuanian researchers develop breakthrough stroke monitoring system

 This would seem to solve the problem of stroke mimics and hard to diagnose cases. But nothing will occur from this; THERE IS NO STROKE LEADERSHIP SOLVING STROKE! Nobody in stroke is doing one damn thing to solve stroke!

Lithuanian researchers develop breakthrough stroke monitoring system

Kaunas University of Technology (KTU)May 16 2025

Stroke is one of the leading causes of long-term disability worldwide. According to the World Health Organization, approximately 15 million people suffer a stroke each year. Of these, 5 million die and another 5 million are left permanently disabled. It is also estimated that someone suffers a stroke every two seconds, and dies from it every six seconds.

When a stroke occurs, every minute counts - it determines how much brain tissue can be saved. But even after successful care during the emergency phase, long-term monitoring becomes crucial, as the long and complex recovery process begins.

Stroke is a critical condition where prompt diagnosis determines the success of treatment. Post-stroke monitoring is equally important, as the patient's condition may worsen."

Dr. Darius Jegelevičius, a researcher at Kaunas University of Technology (KTU), Lithuania

To address this need, Lithuanian scientists have developed a system that simultaneously measures heart activity, pulse propagation, physical movement, and changes in blood flow within brain tissue.

Synchronized signals for stroke insight

One of the system's key innovations is its ability to synchronously record several physiological signals that reflect the activity of the entire circulatory system. According to Dr Jegelevičius, although predicting a stroke is extremely difficult, once it occurs, combining data on the heart's electrical activity, vascular biomechanics, and cerebral blood flow helps create a detailed picture of circulatory processes.

The system registers cardiac activity using an electrocardiogram (ECG) and a photoplethysmogram (FPG), physical motion through an inertial sensor, and cerebral blood flow changes via bioimpedance measurements.

"An ECG reflects the heart's electrical stimulation, which triggers muscle contraction. The FPG, which works by detecting how light is absorbed or reflected by tissue, shows the propagation of blood pulses throughout the body and reflects the biomechanics of the circulatory system," Jegelevičius explains.

What sets this system apart is its use of bioimpedance, an indicator of the tissue's resistance to electrical current. "We all know that electricity flows better in wet environments - water lowers resistance. The same applies to biological tissue: more blood means lower bioimpedance, less blood means higher," he says.

This principle allows the system to detect how blood flow is distributed in the brain, something that changes during and after a stroke. "When a stroke occurs, a blockage in a blood vessel disrupts normal cerebral circulation. These changes are reflected in bioimpedance measurements," he adds.

A step closer to forecasting stroke

Although the system does not yet predict stroke with full certainty, it already helps monitor condition changes and identify potential risks. "We cannot yet claim it will detect a recurrent stroke or other serious event, but the potential is there," says Jegelevičius.

To be effective in different clinical contexts, the system is designed for both short-term and long-term monitoring, including use during rehabilitation. Its two main components - cardiovascular and cerebral bioimpedance monitoring - can function independently, but their combination provides synchronised and more comprehensive physiological data.

This data is not only collected but also processed using a hybrid approach. Some analyses, such as derivative parameters from ECG and FPG, are performed directly on the device. More complex calculations, like the spatial distribution of bioimpedance across the scalp, are handled by an external computer or remote server.

The technology is already protected under a European patent held jointly by Kaunas University of Technology, the Lithuanian University of Health Sciences, and Gruppo Fos Lithuania.

Researchers believe this invention may eventually prove useful not only for post-stroke monitoring but also for managing other neurological and cardiovascular conditions.

The commercialization of the invention is facilitated by the KTU National Innovation and Entrepreneurship Centre.

 

Source:

Kaunas University of Technology (KTU)7u

Stroke Mimics at 30 Years: Where We Have Been, Where We Are Now, and Where We Are Going

 I see nothing about you writing a protocol to solve this problem, SO USELESS CRAPOLA!

Stroke Mimics at 30 Years: Where We Have Been, Where We Are Now, and Where We Are Going

Haroon Khawar, DO https://orcid.org/0009-0009-7928-2568, Spencer McFarlane, MD, and Richard B. Libman, MD https://orcid.org/0000-0002-3978-7985 rlibman@northwell.eduAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.124.048067

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Abstract

Stroke mimics and chameleons remain a major challenge to the clinician and clinical investigator. Misdiagnosis of stroke can result in significant harm to our patients, as well as unnecessary financial costs to the health care systems internationally. The approach to stroke mimics and chameleons has evolved over time with the development of clinical scales and technology. The combination of these tools with clinical acumen can minimize diagnostic errors to the benefit of patients.

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Johns Courage To Be Recognised At National Awards

 Requiring courage to recover from a stroke is an indictment into the complete fucking failures of your stroke medical 'professionals' to get stroke solved to 100% recovery.

Johns Courage To Be Recognised At National Awards

Stroke Foundation

A Drysdale survivor of stroke who made it his mission to walk again in time to farewell his mother has been recognised for his courage.

John O'Dowd had a stroke in 2023, a few years after having a heart attack. He had to learn how to walk again and during the rehabilitation process was dealt another blow; his mother fell ill and passed away.

During this difficult time, John turned his grief into motivation and set himself a goal to walk out of rehabilitation to attend his mother's funeral. To the surprise of doctors and physiotherapists, John achieved this after just only three weeks of rehabilitation.

Now he is being recognised for his courage, being named a finalist for the Courage Award for the Stroke Foundation Stroke Awards.

Stroke Foundation Chief Executive Officer, Dr Lisa Murphy, commended John on his achievement.

"The Courage Award recognises courage and hope shown by survivors and carers in stroke recovery and John has shown immense courage. He overcame major emotional and physical challenges to be able to attend his mother's funeral which would've been a tough moment for him."

The Stroke Awards celebrate the unsung heroes in our community who go above and beyond to improve the lives of Australians affected by stroke. This includes the survivors of stroke, carers, volunteers, fundraisers, health professionals and researchers and members of the community.

The finalists for the Courage Award are:

• Rebecca Schmidt-Lachlan - New South Wales
• Michael Denehy - Queensland
• John O'Dowd - Victoria

There are eight categories in total: Warrior, Improving Life After Stroke, Creative, Courage, First Nations Stroke Excellence, Fundraiser of the Year, Volunteer of the Year and President's Achievement.

The 2024 Stroke Awards are supported by Medtronic, Abbvie, Australian Physiotherapy Association (APA), Ipsen, NAB, Precision Connect and Worrells.

ED evaluation of stroke-like symptoms may be more traumatic than actual stroke diagnosis

 Does your competent? doctor have a protocol for treating such PTSD?

Maybe ecstasy? Or

Psychoactive Ibogaine and Magnesium Show Promise for PTSD

The latest here:

ED evaluation of stroke-like symptoms may be more traumatic than actual stroke diagnosis

Key takeaways:

• Hospitalization for stroke-like symptoms was tied to higher odds of PTSD at 1 month than true stroke diagnosis.
• Preexisting PTSD was linked to higher odds of 1-month PTSD, regardless of the final diagnosis.

Patients who are hospitalized with stroke-like symptoms, but do not experience a stroke, may yet develop PTSD at a higher rate than patients who actually had a stroke, a speaker reported.

Stroke-like symptoms — or stroke mimics — included migraine, numbness and dizziness.

Hospitalization for stroke-like symptoms was tied to higher odds of PTSD at 1 month than true stroke diagnosis.

Image: Adobe Stock

Findings from the ReACH Stroke study were presented at the International Stroke Conference.

“Stroke mimics matter. As clinicians, we may be quick to dismiss a patient’s less life-threatening diagnosis, such as migraine or vertigo. However, these patients may experience significant psychological distress, which can increase their risk for poorer cardiovascular health,” Melinda Chang, MS, ANP-BC, research nurse at the Center for Behavioral Cardiovascular Health at Columbia University Irving Medical Center, said in a press release. “Knowing that being evaluated for stroke in an emergency department can itself be a traumatic experience for many people may help health care professionals recognize PTSD symptoms and connect patients quickly to the appropriate resources.

“Stroke specialists typically view stroke mimics as less serious than a confirmed stroke, so we did not expect patients with stroke mimics to be at higher risk for having PTSD at 1-month follow-up,” Chang said. “However, the neurologists on our team have noted that patients with stroke mimics can suffer significant distress from their stroke-like conditions, so our findings support these clinical experiences.”

To assess the association between stroke mimic, stroke or transient ischemic attack diagnosis and likelihood of PTSD 1 month after the index event, Chang and colleagues enrolled 1,000 patients with suspected stroke or TIA (mean age, 62 years; 51% women) who presented at the Columbia University Irving Medical Center from June 2016 to March 2022.

PTSD was evaluated using the PTSD Checklist-5 at index hospitalization and at 1 month after discharge.

The patients’ charts were reviewed by a neurologist, who was masked to PTSD status and provided a final diagnosis of stroke, TIA, stroke mimic or equivocal.

Overall, 59.6% of the cohort was diagnosed with stroke, 7.9% with TIA and 27.4% with stroke mimic, whereas 5.1% was equivocal or missing.

The researchers reported that the most common stroke mimics were migraine and other headaches, peripheral or cranial neuropathy and peripheral vertigo.

At 1 month, the prevalence of PTSD was 15.1% for patients with stroke mimic, 6.3% for those with stroke and 5.5% for those with TIA.

After adjusting for age, gender, ethnicity, NIH Stroke Scale, modified Rankin Scale score and prior PTSD, the odds for PTSD at 1 month were higher for patients diagnosed with a stroke mimic compared with those who actually experienced a stroke (OR = 2.99, 95% CI, 1.45-6.18; P < .01) but not TIA (P = .45).

Preexisting PTSD was the only covariate linked to PTSD at 1 month and was associated with a 10-fold increased likelihood across all diagnoses (OR = 10.32; 95% CI, 5.3-20.1; P < .01), according to the study.

“It is important for people who are evaluated for stroke to know they are not alone if they experience flashbacks, disrupted sleep or feel on edge after their medical event. They should feel comfortable and empowered to report any concerning symptoms to their health care team so they can get the help they need,” Chang said in the release.

Reference:

• Experiencing “stroke-like” symptoms may be more traumatic than an actual stroke. https://newsroom.heart.org/news/experiencing-stroke-like-symptoms-may-be-more-traumatic-than-an-actual-stroke. Published Feb. 1, 2024. Accessed Feb. 7, 2024.

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Sources/Disclosures

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Source:

Chang M, et al. Abstract Poster WP35. Presented at: International Stroke Conference; Feb. 7-9, 2024; Phoenix.

Disclosures: Chang reports no relevant financial disclosures.

Ischemic stroke mimics: A comprehensive review

How will your stroke hospital guarantee 100% accuracy is diagnosing your stroke? See all these failure points, you don't want this.

So maybe we should eliminate the neurologist and their inaccuracy in detecting strokes.

Pediatric Stroke Often Misdiagnosed, Treatment Delayed

 

Doctors tell boy, 15, he had a migraine after rugby tackle - but he was actually suffering a paralyzing stroke which nearly killed him

 

Factors Associated With Misdiagnosis of Acute Stroke in Young Adults

Amy on her 36 hour wait for a diagnosis.

The latest here:

Ischemic stroke mimics: A comprehensive review

 

• Marietta Pohl
• David Hesszenberger
• Krisztian Kapus
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• Eva Fejes
• Antal Tibold
• Gergely Feher
• Show all authors

Open AccessDOI:https://doi.org/10.1016/j.jocn.2021.09.025 

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Highlights

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  Peripheral vertigo, toxic/metabolic changes, seizure, migraine and functional disorders are the most common stroke mimics.
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  One out of four mimics is thrombolyzed with a very good outcome.
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  Patient evaluation by should be carried by physicians experienced in the diagnosis of both ischemic stroke stroke and mimics.(Why? They have been proven to be inaccurate.)
  

Abstract

Background

Ischemic stroke is the leading cause of disability and one of the leading causes of death. Ischemic stroke mimics (SMs) can account for a noteble number of diagnosed acute strokes and even can be thrombolyzed.

Methods

The aim of our comprehensive review was to summarize the findings of different studies focusing on the prevalence, type, risk factors, presenting symptoms, and outcome of SMs in stroke/thrombolysis situations.

Results

Overall, 61 studies were selected with 62.664 participants. Ischemic stroke mimic rate was 24.8% (15044/60703). Most common types included peripheral vestibular dysfunction in 23.2%, toxic/metabolic in 13.2%, seizure in 13%, functional disorder in 9.7% and migraine in 7.76%. Ischemic stroke mimic have less vascular risk factors, younger age, female predominance, lower (nearly normal) blood pressure, no or less severe symptoms compared to ischemic stroke patients (p < 0.05 in all cases). 61.7% of ischemic stroke patients were thrombolysed vs. 26.3% among SMs (p < 0.001). (p < 0.001). Overall intracranial hemorrhage was reported in 9.4% of stroke vs. 0.7% in SM patients (p < 0.001). Death occurred in 11.3% of stroke vs 1.9% of SM patients (p < 0.001). Excellent outcome was (mRS 0–1) was reported in 41.8% ischemic stroke patients vs. 68.9% SMs (p < 0.001). Apart from HINTS manouvre or Hoover sign there is no specific method in the identification of mimics. MRI DWI or perfusion imaging have a role in the setup of differential diagnosis, but merit further investigation.

Conclusion

Our article is among the first complex reviews focusing on ischemic stroke mimics. Although it underscores the safety of thrombolysis in this situation, but also draws attention to the need of patient evaluation by physicians experienced in the diagnosis of both ischemic stroke and SMs, especially in vertigo, headache, seizure and conversional disorders.

Stroke mimics: incidence, aetiology, clinical features and treatment

Because our stroke medical world can't objectively determine if you have a stroke, YOU WILL NEED TO HAVE CLASSIC SYMPTOMS; slurred speech, drooping arm, slumping face. 

Stroke mimics: incidence, aetiology, clinical features and treatment

Brian H. Buck, Naveed Akhtar, Anas Alrohimi, Khurshid Khan & Ashfaq Shuaib

Pages 420-436 | Received 01 Oct 2020, Accepted 08 Feb 2021, Published online: 06 Mar 2021

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• https://doi.org/10.1080/07853890.2021.1890205
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Abstract

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

The significance of the clinical problem

Stroke is one of the most common diseases affecting one in four people during their lifetime [1]. Most strokes are due to reduction or interruption of blood flow to the brain (ischaemic stroke). A small minority may result from thrombosis in medium or large cerebral veins. Approximately, 20–30% of strokes are haemorrhages and results from damage to small or medium-size vessels [1]. Stroke is a medical emergency and presents with focal neurological deficits. Immediate evaluation, confirmation of diagnosis and treatment to re-establish blood flow leads to improvement in symptoms and prevention of brain damage [2]. The diagnosis of acute ischaemic stroke is however not always straightforward. Similar symptoms may develop in a number of medical conditions commonly referred to as “stroke mimics” (see Table 1). It is essential to entertain stroke mimics in the differential diagnosis when treating an acute suspected stroke to avoid the inappropriate use of expensive and potentially harmful medications. This becomes particularly important with telestroke and in hospitals with limited acute stroke experience [3].

Table 1. Conditions that may be confused as acute stroke (stroke mimics).

CSVDisplay Table

The frequency of stroke mimics is variable and depends where the diagnosis is made and can for 20–50% of cases of acute suspected stroke depending if the patients are evaluated by the emergency personal or stroke physicians [3–5]. Stroke mimics can broadly be classified into two categories. Medical mimics are more common and comprise 50–80% of cases in most large series [4,6]. Functional mimics or conversion disorders are less frequent [7–10]. Although they have characteristic clinical features can sometimes be very difficult to differentiate from an ischaemic stroke (see Table 2). The separation of “new focal neurological symptoms” in the presence of an old stroke, also known as recrudescence, can be particularly challenging. This frequently develops in the settings of an acute infection or metabolic dysfunction and can occur weeks to years following a stroke [11]. Diagnosis may sometimes require magnetic resonance imaging (MRI) to determine if a new stroke is responsible for the focal symptoms. This is important when thrombolysis is being contemplated.

Table 2. Clinical characteristics differentiating stroke from mimic.

CSVDisplay Table

Stroke mimics have less clearly defined neurological symptoms that typically do not adhere to well-defined stroke syndromes [12]. The suddenness at onset is not always evident, fluctuations in severity are common and systemic signs including drowsiness, confusion, agitation and fever may be present [6]. Common presenting symptoms include vertigo and dizziness, altered level of consciousness, paraesthesia and numbness, monoplegia, speech dysfunction, limb ataxia, headache and visual disturbances (see Table 2). There is often a previous history of seizures, migraine, depression or other psychiatric disorders or dementia [4]. Mimics can be particularly difficult to differentiate from acute stroke when symptoms are brief and resolve before the patient is examined, especially when advanced brain imaging including MRI is normal. Prompt identification that symptoms are secondary to a stroke mimic and appropriate treatment of the underlying condition will lead to avoidance of potential misdiagnosis and the unnecessary long-term use of antithrombotic and other stroke prevention medication.

 More at link.

 

Functional Neurological Disorder: A Common and Treatable Stroke Mimic

Good luck out there getting treated properly. 

Functional Neurological Disorder: A Common and Treatable Stroke Mimic

Retinal photos taken in the emergency department helped differentiate transient ischemic attack from stroke mimics in the FOTO-TIA study

You better hope your emergency room doctors are trained in this, especially for young adult strokes.  Or you will need to demand an eye scan in the ER. Hope you are coherent enough to know how to challenge ER doctors on their expertise. Personally I'd prefer these much faster and objective ways of stroke determination, but then I know nothing, I'm not medically trained.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:  

Retinal photos taken in the emergency department helped differentiate transient ischemic attack from stroke mimics in the FOTO-TIA study

Laurel N. Vuong, MD, Praneetha Thulasi, MD, Valérie Biousse, MD, Philip Garza, BS, David W. Wright, MD, Nancy J. Newman, MD, and Beau B. Bruce, MD, PhD

Author information Article notes Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

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Abstract

Objectives:

We evaluated the frequency and predictive value of ocular fundus abnormalities among patients who presented to the emergency department (ED) with focal neurologic deficits to determine the utility of these findings in the evaluation of patients with suspected TIA and stroke.

Methods:

In this cross-sectional pilot study, ocular fundus photographs were obtained using a nonmydriatic fundus camera. Demographic, neuroimaging, and ABCD² score components were collected. Photographs were reviewed for retinal microvascular abnormalities. The results were analyzed using univariate statistics and logistic regression modeling.

Results:

Two hundred fifty-seven patients presented to the ED with focal neurologic deficits, of whom 81 patients (32%) had cerebrovascular disease (CVD) and 144 (56%; 95% confidence interval: 50%–62%) had retinal microvascular abnormalities. Focal and general arteriolar narrowing increased the odds of clinically diagnosed CVD by 5.5 and 2.6 times, respectively, after controlling for the ABCD² score and diffusion-weighted imaging. These fundus findings also significantly differentiated TIA from non-CVD, even after controlling for the ABCD² score.

Conclusions:

Focal and general arteriolar narrowing were independent predictors of CVD overall, and TIA alone, even after controlling for the ABCD² score and diffusion-weighted imaging lesions. The inclusion of nonmydriatic ocular fundus photographs in the evaluation of patients presenting to the ED with focal neurologic deficits may assist in the differentiation of stroke and TIA from other causes of focal neurologic deficits.

Annually in the United States, 200,000 to 500,000 patients experience TIA,¹ with 7% to 14% subsequently having a stroke within 90 days.² A number of scores, particularly the widely used ABCD² score, were developed to determine which patients with TIA have the highest risk of stroke.² However, these scores have serious limitations.^3,–7 Diffusion-weighted imaging (DWI) has revolutionized the differentiation of stroke from TIA.¹ However, a negative DWI does not assist with the difficult, and arguably more important, task of differentiating TIA from non–cerebrovascular diseases, and TIA diagnosis remains very challenging. About 30% to 50% of patients diagnosed with suspected TIA by non neurologists are ultimately determined not to have a TIA by a stroke neurologist.^8,9 Even among non stroke neurologists, agreement about TIA is only moderate to good.¹⁰

Epidemiologic investigations have shown an association between ocular fundus abnormalities and diabetes, cardiovascular disease, and stroke,^11,–17 suggesting that ocular funduscopic findings may be useful in the diagnosis of TIA and stroke in patients who present to the emergency department (ED) with focal neurologic deficits. Nonmydriatic fundus cameras can be used to assess for abnormalities of the ocular fundus, and the cameras are compact, easy to use, and do not require pupillary dilation, making them an ideal tool for non ophthalmologists. We undertook a pilot investigation to evaluate the role of ocular fundus abnormalities in TIA and stroke diagnosis using patients who presented to our ED with focal neurologic deficits during the Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) Study.

True Ischemia or Mimic?

I would much rather trust one of the objective stroke diagnosis tools rather than a neurologist.  Maybe one of these? But will never occur, you are asking neurologists to place patients needs above keeping their job.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

Study Finds New Blood Test Could Help Detect Brain Injury In Minutes

 The latest here:

 

True Ischemia or Mimic?

MRI changes final diagnosis in 30% of TIA and minor stroke cases

by Judy George, Senior Staff Writer, MedPage Today September 23, 2019

Patients with low-risk suspected transient ischemic attack (TIA) and minor stroke had a higher-than-expected rate of true ischemia on MRI, suggesting neurologists' clinical assessment alone did not reliably produce the correct diagnosis, researchers for the prospective, observational DOUBT study reported.
In 1,028 patients with low-risk transient focal neurologic events, diffusion-weighted imaging (DWI) MRI scans found a 13.5% rate of acute ischemic stroke, reported Shelagh Coutts, MD, of the University of Calgary in Canada, and co-authors, in JAMA Neurology. In total, MRI helped revised the final diagnosis in 30.0% of these patients.
"Even experts are not always correct in the diagnosis of TIA mimics," Coutts told MedPage Today.
"Many of the traditional teaching points regarding clinical symptoms can be incorrect, such as slow progression of symptoms from one body part to another," she added. "Classically, we think of that as being a migraine aura. But sometimes, it can be from ischemia."
More than 1 million patients receive a diagnosis of stroke or TIA in the U.S. each year, noted Margy McCullough-Hicks, MD, and Gregory Albers, MD, both of Stanford University, in an accompanying editorial. These patients have an increased risk of stroke the first weeks after the event and need to be identified rapidly and correctly for secondary prevention to be effective. "Accurate diagnosis is important because some secondary preventive strategies carry risks of their own and are usually not appropriate for patients who did not have a TIA or stroke," they noted.
Definitive diagnosis can be elusive in some patients, especially those whose symptoms don't last long or who appear to have a low-risk event: "Patients with symptoms considered low risk often undergo less extensive evaluations, and differentiating between a cerebrovascular ischemic event vs another diagnosis (such as migraine, seizure, or peripheral vertigo) can be particularly difficult based solely on history and results of physical examination," McCullough-Hicks and Albers added.
"Guidelines recommend performing magnetic resonance imaging (MRI) for patients with transient neurologic symptoms to help distinguish TIA from acute infarction," they continued. "However, despite the increasing use of MRI for such patients, current practice does not match the guideline recommendations to obtain an MRI scan as part of the routine evaluation of TIA."
In the multicenter, international DOUBT study, Coutts and colleagues looked at 1,028 patients without previous stroke history -- mostly from Canada -- showing low-risk transient or minor symptoms who were referred to neurology within 8 days of symptom onset from June 2010 to October 2016. Patients' mean age was 63. Symptoms included non-motor or non-speech minor focal neurologic events of any duration, or motor or speech symptoms that lasted 5 minutes or less.
Overall, 732 (71.2%) patients came from an outpatient clinic, the rest from the emergency department. All participants were examined by stroke neurologists. Participants were enrolled as soon as possible after their neurologic event, prior to undergoing MRI. Imaging was performed in a median of 102 hours. Symptoms had resolved by the time of assessment in 63.8% of patients, and median symptom duration was 120 minutes.
A total of 139 patients (13.5%) had acute stroke as defined by diffusion restriction detected on MRI. The final diagnosis was revised in 308 patients (30.0%) after undergoing MRI, and there were 7 (0.7%) recurrent strokes at 1 year.
Imaging also showed that a DWI-positive scan was associated with increased risk of recurrent stroke (RR 6.4; 95% CI 2.4-16.8) at 1 year. Absence of a DWI-positive lesion had a 99.8% negative predictive value for recurrent stroke.
In multivariable modeling, factors tied to MRI evidence of stroke were:

• Older age (OR 1.02; 95% CI 1.00-1.04)
• Male sex (OR 2.03; 95% CI 1.39-2.96)
• Motor or speech symptoms (OR 2.12; 95% CI 1.37-3.29)
• Ongoing symptoms at assessment (OR 1.97; 95% CI 1.29-3.02)
• No prior identical symptomatic event (OR 1.87; 95% CI 1.12-3.11)
• Abnormal results of initial neurologic examination (OR 1.71; 95% CI 1.11-2.65)

A detailed history and neurologic examination only were partially helpful and did not obviate the need for a brain MRI, Coutts and colleagues noted. "Because clinical features are not adequately discriminatory to obviate the need for MRI, a fast-head protocol MRI should be completed in similar patients within the first week after onset of symptoms," they concluded.
The results apply only to a study population of patients evaluated by a stroke neurologist with an initial suspicion of brain ischemia as a potential diagnosis who also had MRI within 8 days of symptom onset, not to patients assessed differently or at later time points, the researchers added. The study did not include vascular imaging, which might have identified more patients at risk for recurrent events.

Last Updated September 23, 2019

The study was funded by a grant from the Canadian Institutes of Health Research.
Researchers reported relationships with the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, Genome Canada, Pfizer, Medtronic, Bristol-Myers Squibb, Bayer, Stryker, Microvention, GE Healthcare, Boehringer Ingelheim, and NoNO Inc.
Editorialists reported relationships with iSchemaView and Genentech.

Primary Source

JAMA Neurology

Source Reference: Coutts SB, et al "Rate and Prognosis of Brain Ischemia in Patients With Lower-Risk Transient or Persistent Minor Neurologic Events" JAMA Neurology 2019; DOI:10.1001/jamaneurol.2019.3063.

Secondary Source

JAMA Neurology

Source Reference: McCullough-Hicks ME, Albers GW "Benefits of Magnetic Resonance Imaging for Patients Presenting With Low-risk Transient or Persistent Minor Neurologic Deficits" JAMA Neurology 2019; DOI:10.1001/jamaneurol.2019.2963.

THE CLINICAL AND DIAGNOSTIC PROFILE OF VERTIGINOUS SYNDROMES IN EMERGENCY DEPARTMENT

What will it take to get 100% accuracy in detecting strokes rather than these mimics? Don't just describe a problem and throw up your hands in defeat. Our stroke leadership should have a strategy to solve this problem. But we have neither so stroke patients will continue to be screwed forever.

THE CLINICAL AND DIAGNOSTIC PROFILE OF VERTIGINOUS SYNDROMES IN EMERGENCY DEPARTMENT

Migraines Mimicking Stroke Still Pose Diagnostic Challenges

What EXACTLY is your stroke hospital doing to not have this error in their ER? Are they even measuring false positives?  

Migraines Mimicking Stroke Still Pose Diagnostic Challenges

Migraine with aura responsible for 18% of improper thrombolytic treatments

• by Judy George, Contributing Writer, MedPage Today November 19, 2018

SCOTTSDALE, Ariz. -- Migraine with aura is one of the three most common conditions, along with seizures and psychiatric disorders, that mimic stroke and can lead to inappropriate thrombolytic treatment, a researcher said here.
"There are other forms of stroke mimics, but these are the big three," said R. Allan Purdy, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, at a plenary session at the American Headache Society Scottsdale Headache Symposium.
"There can't be a neurologist or healthcare professional who hasn't thought about what might happen if tissue plasminogen activator (tPA) is given to a patient with migraine," Purdy noted. "Since 1995 when tPA came out, there's been a concern that, at some point, we might be giving it to a patient with a stroke mimic."
Earlier this year, a systematic review found that migraine with aura was responsible for 1.79% of all emergency stroke unit evaluations, possibly due to efforts to reduce door-to-needle time for tPA (alteplase) stroke treatment. Migraine with aura was the third most common mimic.
Nearly 7% of tPA administrations were for non-stroke events, with migraine making up about 18% of these. Despite a lack of strong supporting data, thrombolysis in migraine with aura appeared to carry an extremely low risk of adverse events (0.01%), the authors concluded.
"This review was important because of what came out almost at the same time, which were the 2018 guidelines for the early management of stroke," said Purdy. Those guidelines stated that "the risk of symptomatic intracranial hemorrhage in the stroke mimic population is quite low; thus, starting IV alteplase is probably recommended in preference over delaying treatment to pursue additional diagnostic studies."
"The key word here is 'probably' -- and this is important to recognize," Purdy said. "On balance, a lot of patients with stroke mimics have been given tPA, and although the untoward event percentage is extremely low, it's never going to be zero."
The aura is the thing to focus on, Purdy pointed out. "It's not the headache that you can analyze and determine whether it's a stroke mimic, because a lot of patients with transient ischemic attack (TIA) and stroke have headache. You have to look at the aura." The secret to distinguishing migraine from stroke may be in cases with a "slow march of a migraine aura over 20 minutes," in contrast to the abrupt onset of aura symptoms in strokes, he said. Unlike stroke, migraine also can involve one side of the tongue, he added.
In the systematic review, migraine patients tended to arrive quickly at the hospital, often within 1 hour of clinical onset. Overall, stroke mimic patients often were younger, more frequently women, had fewer cardiovascular risk factors, and showed psychiatric disorders as the most common comorbidity. The presence of neurological aura in young women, particularly if it involves speech or vision without hemiplegia, could signify a stroke mimic, Purdy noted. While that group also is risk for stroke, especially women who smoke and use oral contraception medication, "this would be a group you would look at very carefully before giving tPA," he said.
"The neurological differential diagnosis is still important in the emergency department," Purdy observed. "One still has to differentiate what's actually going on. This is important; the therapy is not without risk."
It's important to bear in mind that reaching a correct treatment decision requires knowledge of neurovascular anatomy, clinical stroke syndromes, and common mimics -- all while remembering time is brain, Purdy noted. "A quick assessment of patients takes away the opportunity for a reflective assessment, which we were all trained to think about," he said.

Purdy disclosed no relevant relationships with industry.

last updated 11.19.2018

• Primary Source

  AHS Scottsdale Headache Symposium

  Source Reference: Purdy RA “Migraine mimicking stroke: What to do?” SHS 2018.

Migraines Mimicking Stroke Still Pose Diagnostic Challenges

So you better plan on having the classic stroke symptoms(crooked smile, garbled speech, arms not able to lift together). I only had the arms problem and I was not even tested for that, I was fully lucid and conversant, no idea about my smile.  

Migraines Mimicking Stroke Still Pose Diagnostic Challenges

Migraine with aura responsible for 18% of improper thrombolytic treatments

• by Judy George, Contributing Writer, MedPage Today November 19, 2018

SCOTTSDALE, Ariz. -- Migraine with aura is one of the three most common conditions, along with seizures and psychiatric disorders, that mimic stroke and can lead to inappropriate thrombolytic treatment, a researcher said here.
"There are other forms of stroke mimics, but these are the big three," said R. Allan Purdy, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, at a plenary session at the American Headache Society Scottsdale Headache Symposium.
"There can't be a neurologist or healthcare professional who hasn't thought about what might happen if tissue plasminogen activator (tPA) is given to a patient with migraine," Purdy noted. "Since 1995 when tPA came out, there's been a concern that, at some point, we might be giving it to a patient with a stroke mimic."
Earlier this year, a systematic review found that migraine with aura was responsible for 1.79% of all emergency stroke unit evaluations, possibly due to efforts to reduce door-to-needle time for tPA (alteplase) stroke treatment. Migraine with aura was the third most common mimic.
Nearly 7% of tPA administrations were for non-stroke events, with migraine making up about 18% of these. Despite a lack of strong supporting data, thrombolysis in migraine with aura appeared to carry an extremely low risk of adverse events (0.01%), the authors concluded.
"This review was important because of what came out almost at the same time, which were the 2018 guidelines for the early management of stroke," said Purdy. Those guidelines stated that "the risk of symptomatic intracranial hemorrhage in the stroke mimic population is quite low; thus, starting IV alteplase is probably recommended in preference over delaying treatment to pursue additional diagnostic studies."
"The key word here is 'probably' -- and this is important to recognize," Purdy said. "On balance, a lot of patients with stroke mimics have been given tPA, and although the untoward event percentage is extremely low, it's never going to be zero."
The aura is the thing to focus on, Purdy pointed out. "It's not the headache that you can analyze and determine whether it's a stroke mimic, because a lot of patients with transient ischemic attack (TIA) and stroke have headache. You have to look at the aura." The secret to distinguishing migraine from stroke may be in cases with a "slow march of a migraine aura over 20 minutes," in contrast to the abrupt onset of aura symptoms in strokes, he said. Unlike stroke, migraine also can involve one side of the tongue, he added.
In the systematic review, migraine patients tended to arrive quickly at the hospital, often within 1 hour of clinical onset. Overall, stroke mimic patients often were younger, more frequently women, had fewer cardiovascular risk factors, and showed psychiatric disorders as the most common comorbidity. The presence of neurological aura in young women, particularly if it involves speech or vision without hemiplegia, could signify a stroke mimic, Purdy noted. While that group also is risk for stroke, especially women who smoke and use oral contraception medication, "this would be a group you would look at very carefully before giving tPA," he said.
"The neurological differential diagnosis is still important in the emergency department," Purdy observed. "One still has to differentiate what's actually going on. This is important; the therapy is not without risk."
It's important to bear in mind that reaching a correct treatment decision requires knowledge of neurovascular anatomy, clinical stroke syndromes, and common mimics -- all while remembering time is brain, Purdy noted. "A quick assessment of patients takes away the opportunity for a reflective assessment, which we were all trained to think about," he said.

Purdy disclosed no relevant relationships with industry.

last updated 11.19.2018

• Primary Source

  AHS Scottsdale Headache Symposium

  Source Reference: Purdy RA “Migraine mimicking stroke: What to do?” SHS 2018.

Safety of Intravenous Thrombolysis in Stroke Mimics

So rather than coming up with a solution to accurately diagnose a stroke they studied what happens when they incorrectly gave tPA. Don't these people have a clue about solving the correct problem?
http://stroke.ahajournals.org/content/46/5/1281.abstract?etoc

Prospective 5-Year Study and Comprehensive Meta-Analysis

1. Georgios Tsivgoulis, MD;
2. Ramin Zand, MD;
3. Aristeidis H. Katsanos, MD;
4. Nitin Goyal, MD;
5. Ken Uchino, MD;
6. Jason Chang, MD;
7. Efthimios Dardiotis, MD;
8. Jukka Putaala, MD;
9. Anne W. Alexandrov, PhD;
10. Marc D. Malkoff, MD;
11. Andrei V. Alexandrov, MD

+ Author Affiliations

1. From the Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., R.Z., N.G., J.C., A.W.A., M.D.M., A.V.A.); Second Department of Neurology, “Attikon University Hospital,” School of Medicine, University of Athens, Athens, Greece (G.T., A.H.K.); Department of Neurology, Cerebrovascular Center, Cleveland Clinic, OH (K.U.); Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece (E.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (J.P.); and College of Nursing, Australian Catholic University, Sydney, New South Wales, Australia (A.W.A.).

1. Correspondence to Georgios Tsivgoulis, MD, Second Department of Neurology, University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens, Greece 15344. E-mail tsivgoulisgiorg@yahoo.gr

Abstract

Background and Purpose—Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series.

Methods—We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1.

Results—Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3–22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%–2%) and 0.3% (95% confidence interval, 0%–2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14–0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07–3.73; P<0.00001).

Conclusions—Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.

Safety of Intravenous Thrombolysis in Stroke Mimics

This is absolutely appalling. There are  enough cases of misdiagnosis of stroke out there to conduct research on them. And they even do the wrong type of research. They should be studying why they misdiagnosed rather than seeing if what they did was bad. Doesn't anyone use the few remaining brain cells they have to determine the correct items to research? I really think everyone out there in the stroke medical world should be replaced by stroke survivors, we at least would solve the correct problems. This is because of the f*cking laziness of doing meta-analysis rather than original research and the total lack of data gathering by our stroke associations on strokes.
http://stroke.ahajournals.org/content/early/2015/03/19/STROKEAHA.115.009012.abstract?papetoc

Prospective 5-Year Study and Comprehensive Meta-Analysis

1. Georgios Tsivgoulis, MD,
2. Ramin Zand, MD,
3. Aristeidis H. Katsanos, MD,
4. Nitin Goyal, MD,
5. Ken Uchino, MD,
6. Jason Chang, MD,
7. Efthimios Dardiotis, MD,
8. Jukka Putaala, MD,
9. Anne W. Alexandrov, PhD,
10. Marc D. Malkoff, MD and
11. Andrei V. Alexandrov, MD

+ Author Affiliations

1. From the Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., R.Z., N.G., J.C., A.W.A., M.D.M., A.V.A.); Second Department of Neurology, “Attikon University Hospital,” School of Medicine, University of Athens, Athens, Greece (G.T., A.H.K.); Department of Neurology, Cerebrovascular Center, Cleveland Clinic, OH (K.U.); Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece (E.D.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (J.P.); and College of Nursing, Australian Catholic University, Sydney, New South Wales, Australia (A.W.A.).

1. Correspondence to Georgios Tsivgoulis, MD, Second Department of Neurology, University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens, Greece 15344. E-mail tsivgoulisgiorg@yahoo.gr

Abstract

Background and Purpose—Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series.

Methods—We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1.

Results—Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3–22), SMs comprised 75 cases.(A 14.5% failure rate!!!) Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%–2%) and 0.3% (95% confidence interval, 0%–2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14–0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07–3.73; P<0.00001).