laf2020-ga,
pinkfreud-ga has given you a very comprehensive and fairly current
link to a review article on stroke mimics (in the comments section,
below).
In addition to that article, there are other materials that will
provide some excellent insights into this topic.
Probably the most significant is a recent article in the journal, Stroke:
http://stroke.ahajournals.org/cgi/content/abstract/37/3/769
Distinguishing Between Stroke and Mimic at the Bedside
Stroke. 2006;37:769
Correspondence to Dr Peter Hand, Department of Neurology, c/-Post
Office, Royal Melbourne Hospital, Victoria 3050, Australia. E-mail
peter.hand@mh.org.au
Background and Purpose? The bedside clinical assessment of the patient
with suspected stroke has not been well studied. Improving clinical
skills may accelerate patient progress through the emergency
department. We aimed to determine the frequency and nature of stroke
mimics and to identify the key clinical features that distinguish
between stroke and mimic at the bedside.
Take particular note of Table 2 in the article:
http://stroke.ahajournals.org/cgi/content-nw/full/37/3/769/TBL2
TABLE 2. Causes of Stroke Mimics (n=109)*, Subdivided by Time to Presentation
which identifies 109 incidents of stroke mimics, subdivided into 13 categories:
Seizure
Sepsis
Toxic/metabolic
Space occupying lesion
Syncope/presyncope
Acute confusional state
Vestibular dysfunction
Acute mononeuropathy
Functional/medically unexplained symptoms
Dementia
Migraine
Spinal cord lesion
Other
==============================
I have also found emedicine to be a very reliable, very professional
source of up-to-date information on diseases, treatments and
diagnostics. They offer this review of stroke mimics:
http://www.emedicine.com/EMERG/topic558.htm
...Stroke mimics commonly confound the clinical diagnosis of stroke.
One study reported that 19% of patients diagnosed with acute ischemic
stroke by neurologists before cranial CT scanning actually had
noncerebrovascular causes for their symptoms. The most frequent stroke
mimics include seizures (17%); systemic infections (17%); brain tumors
(15%); toxic-metabolic causes, such as hyponatremia (13%); and
positional vertigo (6%). Miscellaneous disorders mimicking stroke
include syncope, trauma, subdural hematoma, herpes encephalitis,
transient global amnesia, dementia, demyelinating disease, myasthenia
gravis, parkinsonism, hypertensive encephalopathy, and conversion
disorders. A critical masquerading metabolic derangement not to be
missed by providers is hypoglycemia...
==============================
And in addition, take note of this study:
[this is virtually the same information as provided in the link that
pinkfreud-ga, but it includes information on the author, including
contact information]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12379962&query_hl=1&itool=pubmed_DocSum
Stroke mimics and chameleons.
Emerg Med Clin North Am. 2002 Aug;20(3):583-95.
Huff JS.
University of Virginia Health System, Department of Emergency
Medicine, P. O. Box 800699, Charlottsville, VA 22908-0699 USA.
jshuff@virginia.edu
==============================
The three links above really do an excellent job of covering the
current territory on the topic of stroke mimics.
Other studies also worth noting are:
[This one sounds relevant, but only an abstract is available online,
and it's not clear how thoroughly the article addresses mimics. You
may want to ask a librarian for a copy of the full article]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15900010&query_hl=3&itool=pubmed_docsum
Is this patient having a stroke?
JAMA. 2005 May 18;293(19):2391-402
Goldstein LB, Simel DL.
Department of Medicine, Duke Center for Cerebrovascular Disease,
Durham, NC 27710, USA. golds004@mc.duke.edu
CONTEXT: Patients suspected of having a stroke or transient ischemic
attack require accurate assessment for appropriate acute treatment and
use of secondary preventive interventions. OBJECTIVE: To update a 1994
systematic review of the accuracy and reliability of symptoms and
findings on neurological examination for the evaluation of patients
with suspected stroke or transient ischemic attack.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14581912&query_hl=3&itool=pubmed_docsum
Misdiagnosis of stroke in tissue plasminogen activator-treated
patients: characteristics and outcomes.
Ann Emerg Med. 2003 Nov;42(5):611-8.
Scott PA, Silbergleit R.
Department of Emergency Medicine, University of Michigan, Ann Arbor,
MI 48109-0303, USA. phillip.scott@umich.edu
STUDY OBJECTIVE: Misdiagnosis of acute ischemic stroke is a risk
inherent in treating patients with acute deficits, yet few data exist
on the problem. We report an evaluation of emergency department
misdiagnoses in patients treated with tissue plasminogen activator for
acute ischemic stroke.
[A small but significant number of patients with brain tumors can
present as stroke victims]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10582668&query_hl=3&itool=pubmed_docsum
Brain tumor masquerading as stroke.
J Neurooncol. 1999 Aug;44(1):47-52.
Morgenstern LB, Frankowski RF.
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland,
USA. Imorgens@neuro.med.uth.tmc.edu
Discriminating brain tumor from stroke in patients presenting with
acute focal neurologic signs and symptoms is crucial to avoid improper
treatment, or delay correct treatment of the brain tumor patient. Data
from the era before computed tomography (CT) suggests that 3% of
patients with brain tumors are initially thought to have had a stroke.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10468475&dopt=Abstract
CNS symptoms caused by hypoglycemia: frequent misdiagnosis: "stroke".
Pitfall of the neuroglycopenia syndrome
MMW Fortschr Med. 1999 Jun 3;141(22):42-4
[Article in German]
Holstein A, Egberts EH.
Medizinische Klinik I, Klinikum Lippe-Detmold, Universitat Munster/Westf.
Hypoglycemia may occur without classic symptoms, especially in elderly
patients hypoglycemia may imitate nearly every neurological symptom.
The neuroglycopenic syndrome, which is often due to
sulfonylurea-induced hypoglycemia, is frequently overlooked or
misinterpreted as cerebral ischemia. Therefore in every case of
disturbance of consciousness, acute neurologic deficits and
psychiatric abnormalities an immediate blood glucose test should be
performed to exclude hypoglycemia...
http://stroke.ahajournals.org/cgi/content/full/strokeaha;37/3/754
Improving the Clinical Diagnosis of Stroke
Stroke. 2006;37:754
Correspondence to Larry B. Goldstein, MD, Box 3651, Duke University
Medical Center, Durham, NC 27710. E-mail golds004@mc.duke.edu
http://stroke.ahajournals.org/cgi/content/full/37/3/776?ijkey=476f61bcb205a4eaedb59ecf443003dd5b955d0d
Interobserver Agreement for the Bedside Clinical Assessment of Suspected Stroke
Stroke. 2006;37:776
Correspondence to Dr Peter Hand, Department of Neurology, c/- Post
Office, Royal Melbourne Hospital, Victoria 3050, Australia. E-mail
peter.hand@mh.org.au
I trust these resources will give you the information you were seeking
on the current state of our understanding of conditions that can
resemble stroke in terms of how they present themselves to medical
staff.
If there's anything more I can do for you, please let me know by
posting a Request for Clarification, and I'm at your service.
All the best,
pafalafa-ga
search strategy -- searched Google and medical databases for [ stroke mimic ] |
