Conditions That Mimic Stroke in the Emergency Department

Rb, Libman; Wirkowski, Elzbieta; Alvir, José; Th, Rao

doi:10.1001/archneur.1995.00540350113023

Cited by 262 publications

(167 citation statements)

References 12 publications

Supporting

Mentioning

143

Contrasting

Unclassified

Order By: Relevance

“…In one of the studies, if the patient had decreased level of consciousness and normal eye movements, the odds of him suffering from a mimic increased. While odds decreased if the patient atrial fibrillation on EKG or history of angina [8]. This was well reflected in our patient as well.…”

supporting

confidence: 80%

Opium Overdose: “A Black Sheep in Acute Stroke Management”

Mansoor¹

2017

JNSK

View full text Add to dashboard Cite

Submit Manuscript | http://medcraveonline.com unconsciousness while he was having his breakfast. A stroke code was announced and neurology was consulted. In his medical history he was Diabetic type 2 for 25 years and hypertensive for 20 years. He was taking oral hypoglycemics (Metformin, Gliclazide) and antihypertensives (Zestril) with adequate compliance. In his personal history he was also an oral opium addict for last 40 years. On examination he was a thin old gentleman not oriented in time, place and person. His Glasgow Comma Scale (GCS) for conscious status was E2M5V1=8/15. Vital signs were a blood pressure of 160/90mmHg, heart rate was 90/minute, and temperature of 98.6 Fahrenheit. Neurological exam revealed central gaze, doll's eye and corneal reflexes were intact. Pupils were 2mm in size which were sluggish to direct and indirect light and nystagmus was not observed. Facial sensation to pain was intact assessed by grimace with a preserved facial symmetry. His tongue was central without any fasciculation. Uvula was central and gag reflex was present. Motor exam showed normal bulk and tone. Power in his limbs to painful stimulus was 3/5 in both upper limbs and 2/5 in both lower limbs approximately. Deep tendon reflexes were 2+ in upper limbs and 1+ in both lower limbs with bilateral flexor plantar responses. Sensory examination to pain was grossly adequate in all limbs. Neck was supple with no signs of meningeal irritation. Systemic examination was normal with no heart murmurs, abnormal breath sounds or visceromegaly. Laboratory workup is shown in Table 1.Computed tomography (CT-scan) of the brain acquired 1 hour 30 minutes into his symptoms showed mild cortical atrophy, normal sized ventricles and no intracranial bleed. He was being considered for intravenous thrombolysis for possibility of posterior circulation ischemic stroke. Other differential included opium overdose due to his chronic addiction. He was given 0.4mg of intravenous naloxone to which he responded within 1 minute and regained his consciousness. GCS improved to 15/15. Stroke code was called off. He was admitted for 24 hours during which he had restlessness and irritability. He was discharged after 2 days in stable condition with regular follow-ups in psychiatry and medicine clinics for long term rehabilitation for his chronic addiction. DiscussionThere have been many studies highlighting the most important mimics of stroke. In one of the studies, if the patient had decreased level of consciousness and normal eye movements, the odds of him suffering from a mimic increased. While odds decreased if the patient atrial fibrillation on EKG or history of angina [8]. This was well reflected in our patient as well. In another study cognitive impairment and abnormal signs in other systems suggested a mimic while if the exact onset time was known along the focal neurological signs the odds of having a stroke were increased. This was also found to be in line with our patient [3]. There have been AbstractWe report a case of an 81 year old elderly man ...

show abstract

supporting

confidence: 80%

Opium Overdose: “A Black Sheep in Acute Stroke Management”

Mansoor¹

2017

JNSK

View full text Add to dashboard Cite

show abstract

“…Furthermore, non‐convulsive status epilepticus, which is a pathological condition that suddenly results in speech disorders, cognitive impairment, and sensory disturbance without convulsions, is known as a type of epilepsy 13. Therefore, we considered that differentiating between non‐convulsive status epilepticus and stroke is more difficult.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of stroke mimics in the emergency department

Okano

Ishimatsu

Kato

et al. 2018

Acute Medicine & Surgery

View full text Add to dashboard Cite

AimTo clarify the features of stroke mimics.MethodsWe retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue‐type plasminogen activator treatment time window.ResultsOf 1,557 suspected acute stroke cases examined at the emergency department, 137 (8.8%) were stroke mimics. The most common causes were symptomatic epilepsy (28 cases, 20.4%), neuropathy‐like symptoms (21 cases, 15.3%), and hypoglycemia (15 cases, 10.9%). Outcomes were survival to hospital discharge for 91.2% and death for 8.8% of the cases. Clinical results were significantly different between stroke mimics and the stroke group for low systolic blood pressure, low National Institutes of Health Stroke Scale score on initial treatment, history of diabetes, and no history of arrhythmia. On multivariate analysis, distinguishing factors for stroke mimics include systolic blood pressure ≤ 140 mmHg, National Institutes of Health Stroke Scale score ≤ 5 points, history of diabetes, and no history of arrhythmia.ConclusionsFrequency of stroke mimics in cases of acute stroke suspected cases is 8.8%, and the most common cause is epilepsy. In order to distinguish stroke mimics, it is useful to understand common diseases presenting as stroke mimics and evaluate clinical features different from stroke by medical interview or nerve examination.

show abstract

“…A report of 411 initial ER stroke diagnoses identified 19% as ''stroke mimics;'' the most common mimic diagnoses were seizure, systemic infection, brain tumor, and toxic-metabolic. 5 The same study identified ''decreased level of alertness'' as associated with a final mimic diagnosis and history of angina as associated with a final diagnosis of stroke. Another study looked at 350 presentations with an initial stroke diagnosis and found 31% ''stroke mimics;'' similarly, the main alternative diagnoses were seizure, sepsis, toxic-metabolic, space-occupying lesion, and syncope/presyncope.…”

Section: Differential Diagnosismentioning

confidence: 92%

Management of ischemic stroke: Part 1. Emergency room management

Lu-Emerson

Likosky

Amin

et al. 2010

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients acutely. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally and includes many aspects of initial evaluation and treatment.PURPOSE:Acute treatment involves the rapid assimilation of patient characteristics, laboratory results, and imaging results. There are a growing number of potential acute therapies with a range of risk, benefit, necessary time windows, and specific eligibility criteria.DATA SOURCES:Primary trials, current guidelines.CONCLUSIONS:The hospitalist is well‐positioned to play a major role in the treatment of stroke patients as well as the systems work that aids in the management of this population. Journal of Hospital Medicine 2010;5:33–40. © 2010 Society of Hospital Medicine.

show abstract

Conditions That Mimic Stroke in the Emergency Department

Abstract: For the neurologist faced with an immediate decision as to whether to randomize a patient with probable stroke to an acute treatment protocol, these findings have some usefulness but mandate further research into conditions that mimic stroke in the emergency department.

Cited by 262 publications

References 12 publications

Opium Overdose: “A Black Sheep in Acute Stroke Management”

Opium Overdose: “A Black Sheep in Acute Stroke Management”

Clinical features of stroke mimics in the emergency department

Management of ischemic stroke: Part 1. Emergency room management

Contact Info

Product

Resources

About