Stroke mimics: incidence, aetiology, clinical features and treatment

Abstract

Mimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

Ischemic stroke mimics: A comprehensive review

“…On the other hand, population based data have shown that stroke is the underlying cause of epilepsy in older adults in more than 30% [6]. After having a post-stroke seizure recovery is rapid in most patients (see above) although rarely non-convulsive status epilepticus may present with prolonged aphasia or motor weakness [84].…”

“…Symptoms are mostly short-lived and show improvement within 24 h in most subjects. Recrudescence can develop within weeks to years after the previous stroke [84,100]. The recrudescence under metabolic, infection, fatigue or sedative medications is likely due to functional suppression of compensatory cerebral networks [84,100] (Fig.…”

Profile of practices and knowledge on stroke among Polish emergency medical service staff

“…Stroke mimic is a non-vascular disease characterized by acute neurological deficits comparable to those associated with stroke. According to several small studies, up to one-third of patients evaluated acutely by a stroke team and up to 15% of patients treated with intravenous tissue plasminogen activator (t-PA) have such stroke mimics; possible etiologies include seizures, tumors, migraine, infections, delirium, peripheral nerve injuries, multiple sclerosis, and conversion disorders [12][13][14].…”

Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis

“…Stroke is a medical emergency and requires immediate evaluation, confirmation of diagnosis and treatment in order to prevent brain damage 16 . The acute ischaemic stroke chain of recovery involves recognition (of symptoms), reaction (emergency services alerted), response (medical assessment), reveal (brain imaging), and Rx (treatment initiation) 17 .…”