Atypical painful stroke presentations: A review

Abstract

Stroke is a leading cause of death and disability. Reperfusion therapies with intravenous thrombolysis and mechanical thrombectomy have greatly improved outcomes but the therapeutic time window remains narrow. 1 Prehospital delay and presentation outside this time window is the leading cause of not receiving reperfusion therapy 2 Causes of prehospital delay are multifactorial but impaired stroke symptom awareness and help seeking behavior in patients and missed identification of stroke by healthcare professionals may play an important role. 3,4 Some patients may present with atypical symptoms leading to an initial misdiagnosis, increased prehospital delay, and missed treatment with thrombolysis or thrombectomy.Stroke "chameleons" are patients with actual stroke who have atypical or unusual presentations, mimicking a non-vascular cause. 5 Presenting as a "stroke chameleon" may be associated with a worse outcome. 6 One of the very rare presentations of stroke is initial neurogenic pain. Post-stroke pain is well-known amongst neurologists but pain as an initial symptom of stroke is not a well-known entity.It has been anecdotally described but a review of painful stroke presentations has not been published previously. Acute trigeminal neuralgia, atypical facial pain, hemisensory pain, and episodic pain