Stroke Chameleons

Dupre, Callum M.; Libman, Richard B.; Dupre, Samuel I.; Katz, Jeffrey M.; Rybinnik, Igor; Kwiatkowski, Thomas

doi:10.1016/j.jstrokecerebrovasdis.2013.07.015

Cited by 53 publications

(38 citation statements)

References 15 publications

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“…The most common chameleons are hypertensive emergency, syncope, or infection. [9][10][11] Our study examined the diagnosis of acute ischemic stroke in the ED of an academic teaching hospital and a large community hospital. Each hospital has a distinct process by which it evaluates acute ischemic stroke.…”

mentioning

confidence: 99%

Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services

Arch

Weisman

Coca

et al. 2016

Stroke

161

106

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A retrospective chart review was performed on all patients with a discharge diagnosis of ischemic stroke during a 1-year period from Background and Purpose-The failure to recognize an ischemic stroke in the emergency department is a missed opportunity for acute interventions and for prompt treatment with secondary prevention therapy. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. Methods-A retrospective chart review was performed from February 2013 to February 2014. Results-A total of 465 patients with ischemic stroke were included in the analysis; 280 patients from the academic hospital and 185 patients from the community hospital. One hundred three strokes were initially misdiagnosed that is 22% of the included strokes at the combined centers. Fifty-five of these were missed at the academic hospital (20%) and 48 were at the community hospital (26%, P=0.11). Thirty-three percent of missed cases presented within a 3-hour time window for recombinant tissue-type plasminogen activator eligibility. An additional 11% presented between 3 and 6 hours of symptom onset for endovascular consideration. Symptoms independently associated with greater odds of a missed stroke diagnosis were nausea/vomiting (odds ratio, 4.02; 95% confidence interval, 1.60-10.1), dizziness (odds ratio, 1.99; 95% confidence interval, 1.03-3.84), and a positive stroke history (odds ratio, 2.40; 95% confidence interval, 1.30-4.42). Thirty-seven percent of posterior strokes were initially misdiagnosed compared with 16% of anterior strokes (P<0.001). Conclusions-Atypical symptoms associated with posterior circulation strokes lead to misdiagnoses. This was true at both an academic center and a large community hospital. Future studies need to focus on the evaluation of identification systems and tools in the emergency department to improve the accuracy of stroke diagnosis. (Stroke. 2016;47:668-673.

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mentioning

confidence: 99%

Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services

Arch

Weisman

Coca

et al. 2016

Stroke

161

106

View full text Add to dashboard Cite

show abstract

“…25 The risk of misdiagnosis is higher in younger patients and those with either mild symptoms or coma. 9 In a recent analysis, 37% of posterior circulation strokes were initially missed compared with 16% of anterior circulation strokes, probably as patients presented with 'non-traditional' symptoms of confusion, altered gait and dizziness rather than conventional lateralising signs.…”

Section: Missed Diagnoses and Stroke Chameleonsmentioning

confidence: 99%

Mimics and chameleons in stroke

Anathhanam¹,

Hassan

2017

Clinical Medicine

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Ischaemic stroke is a treatable medical emergency. In an era of time-dependent reperfusion techniques, it is crucial that an accurate and prompt diagnosis is made. Approximately 30% of patients admitted to hyperacute stroke units are subsequently found not to have a fi nal diagnosis of acute stroke although some of these patients do have incidental or previously symptomatic cerebrovascular disease. These patients do not benefi t from thrombolysis and may require the input of other specialists or treatments. Meanwhile, a proportion of patients with acute stroke have unusual presentations and are sometimes initially admitted to general medical admissions units prior to accessing stroke unit care. It is important that atypical presentations of stroke are recognised so that patients are not denied the benefi ts of stroke unit care and secondary prevention. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging.

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“…Stroke may present as TLOC that leads in turn to head injury [26]. However, correlations between the location of head trauma and focal signs and symptoms related to stroke may be helpful in distinguishing them.…”

Section: Limitationsmentioning

confidence: 99%