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J Brain Dis. 2009 Mar 31;1:19-22. Print 2009.

Identification of stroke mimics in the emergency department setting.

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  • 1Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Republic of Ireland. ; Department of Neurology, Mayo Clinic Arizona, U.S.A.



Previous studies have shown a stroke mimic rate of 9%-31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics.


This was a retrospective cohort observational study. Consecutive "stroke alert" patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as "stroke" or "stroke mimic". Multivariable regression analysis was used to define clinical predictors of stroke mimic.


206 patients were reviewed. 22% were classified as stroke mimics. Multivariable scoring did not help in identification of stroke mimics. 99.5% of patients had a neurological diagnosis at final diagnosis.


22% of patients with suspected acute stroke had a stroke mimic. The aetiology of stroke mimics was varied, with seizure, encephalopathy, syncope and migraine being commonest. Multivariable scoring for identification of stroke mimics is not feasible. 99.5% of patients had a neurological diagnosis. This strengthens the case for the involvement of stroke neurologists/stroke physicians in acute stroke care.


stroke; stroke mimic; transient ischemic attack

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