Epidemiology of functional stroke mimic patients: a systematic review and meta‐analysis

Abstract

Stroke mimics form a significant proportion of cases in acute stroke services and some present with functional neurological disorder. Little is known about the prevalence or clinical characteristics of functional stroke mimics (FSMs). A systematic literature search and meta‐analysis were carried out on published studies reporting suspected stroke and stroke mimic rates; 114 papers met the inclusion criteria of which 70 provided an FSM rate. Random‐effects models estimated prevalence rates across settings and moderators of FSM rate. Pooled proportions indicated that 25% [95% confidence intervals (CI), 22–27%] of suspected stroke cases were stroke mimics. Within the 67 studies providing positive FSM rates, FSMs represented 15% (95% CI, 13–18%) of stroke mimics and 2% (95% CI, 2–3%) of suspected strokes. FSMs were younger and more likely to be female, and presented more with weakness/numbness but less with reduced consciousness or language problems. Stratified analyses suggested higher stroke mimic rates in primary care versus acute settings (38% vs. 12%) but higher FSM rates in stroke units compared with primary care (24% vs. 12%). Functional rates were higher in studies that were descriptive, retrospective and in patients receiving thrombolysis. Several studies reported the proportion of functional stroke patients presenting to stroke services. FSMs have discernible demographic and clinical characteristics, but there is a conspicuous lack of evidence on their presentation or guidance for treatment. The social and psychological mechanisms underlying FSM presentations need more accurate quantification to help inform stroke pathways and improve care for these patients.

<p>Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study</p>

“…Six themes emerged from qualitative data analysis: 1 physical symptom experiences, 2 emotional and coping responses, 3 symptom causes, 4 hospital experiences, 5 views on the future, and 6 uncertainty after hospital discharge.…”

“…This is partly a practical requirement, as staff await scan results before giving definitive diagnoses and patients with functional stroke are more likely to receive brain imaging as doctors seek to mitigate risks of falsenegative diagnoses. 3 Ambiguous bedside consultations 31 coupled with the speed of admission, urgency of diagnostic screening, and sharing a ward with acutely unwell stroke sufferers may compound initial confusion and lead to purely biological symptom perceptions.…”

“…The same topic guide was followed for both sets of interviews, but follow-up interviews explored experiences since discharge, rather than experiences on the ward. The topic guide explored 1 admission experiences, 2 history and experience of symptoms, 3 illness beliefs and attitudes, and 4 views on the future. All interviews were transcribed verbatim by NOC and AJ.…”

“…Approximately 25% of suspected stroke cases are "stroke mimics" and 2% patients with functional symptoms -"functional stroke mimics" (FSMs). 3 Patients present with neurological patterns resembling stroke superficially, but indicate no specific neurological disorder and have negative findings upon diagnostic testing. FSMs tend to be younger, female, and more frequently present with weakness or numbness compared to other stroke mimics.…”

“…FSMs tend to be younger, female, and more frequently present with weakness or numbness compared to other stroke mimics. 3 How patients experience and interact with the healthcare system can help predict future health outcomes and aid in the design of treatment programs. Previous qualitative research suggests patients with functional symptoms may experience confusion following clinical encounters, and can hold negative attitudes toward clinicians.…”