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
• 
  
• 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.