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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.

Abstract

BACKGROUND AND PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

DISCUSSION:

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.

KEYWORDS:

stroke; stroke mimic; transient ischemic attack

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