The Burden of Stroke Mimics: Present and Future Projections

Faiz, Kashif Waqar; Labberton, Angela S; Thommessen, Bente; Rønning, Ole Morten; Dahl, Fredrik A.; Barra, Mathias

doi:10.1016/j.jstrokecerebrovasdis.2017.12.011

Cited by 22 publications

(23 citation statements)

References 26 publications

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“…Both dizziness/vertigo and syncope/collapse are common stroke mimics, as they may produce neurological symptoms that are difficult to separate from acute stroke. 221,223 In our study, these mimic diagnoses were spread out over the follow-up period without any clustering early after index stroke. One explanation for this might be that these symptoms are common in an ageing population.…”

Section: Stroke Mimicsmentioning

confidence: 53%

“…220 Conditions like infections, migraine, seizures, syncope, vertigo, confusional states and functional symptoms are frequent stroke mimics. [221][222][223][224] Stroke mimics lead to costly hospital admissions and are stressful for the patients and their family. 225 Recognition of stroke mimics is therefore highly important, especially in an era with constant focus on shortening the time from hospital admission to administration of thrombolysis (door-to-needle time).…”

Section: Stroke Mimics After Incident Strokementioning

confidence: 99%

“…These patients are projected to suffer both more recurrences and more hospital admissions with stroke mimics. 223 Knowledge about the risk, the risk factors and the consequences of recurrence and stroke mimics is of value for every clinician treating ischemic stroke patients.…”

Section: Future Perspectivesmentioning

confidence: 99%

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Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Khanevski

Kvistad

Novotný

et al. 2019

Stroke

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Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. The objective of this study was to calculate the incidence of SM in IS survivors, compare it with the incidence of recurrent stroke in the same population, and explore the time-dependent patterns of SM etiologies. Methods— This prospective cohort study registered SM events and etiologies among 1872 IS and transient ischemic attack survivors diagnosed with index stroke at Haukeland University Hospital stroke unit from 2007 to 2013 by review of medical records. Cumulative incidences of SM were estimated with a competing risks Cox model and compared with incidence of recurrent stroke in the same population. Results— During 8172 person-years of follow-up, 339 patients had 480 SM events. The cumulative incidence rate of SM during follow-up was 58.7 per 1.000 person-years (95% CI, 53.7–64.2) compared with 34.0 per 1.000 person-years (95% CI, 30.2–38.2) for recurrent stroke in the same time period. The risks of SM and recurrent stroke were highest the first year after index IS or transient ischemic attack. The most frequent SM diagnoses were sequelae of cerebral infarction (19.8%), medical observation, and evaluation for suspected cerebrovascular disease (15.6%) and infections (14.0%). The 2 most frequent and unspecific diagnoses (sequelae of cerebral infarction and medical observation) were clustered in the first months after index stroke. Conclusions— SM after IS or transient ischemic attack are more frequent than recurrent stroke and the risk is especially high in the early period. SMs are multietiological and unspecific diagnoses are most frequent early after index stroke.

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Section: Stroke Mimicsmentioning

confidence: 53%

Section: Stroke Mimics After Incident Strokementioning

confidence: 99%

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Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Khanevski

Kvistad

Novotný

et al. 2019

Stroke

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“…Literature review shows that stroke units can receive 2-38% of patients presenting stroke mimics and this number seems to be higher in larger stroke centers 10,[19][20][21][22][23]31 .…”

Section: Discussionmentioning

confidence: 99%

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials

Ifergan

Amelot

Ismail

et al. 2020

Arq. Neuro-Psiquiatr.

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A larger therapeutic window for stroke treatment requires a significant change in the organization of emergency services, avoiding the increase in number of imaging exams and indirectly the time to treatment. Objective: To highlight the relation between faster clinical evaluation and stroke over-suspicion and consequently excessive imaging acquisition. To identify predictors of ischemic stroke and stroke mimics (SM), aiming for better patient selection for comprehensive neuroimaging and reperfusion therapies. Methods: Retrospective, cohort, observational, single-center study that reviewed all consecutive files of patients presenting with acute neurological symptoms who underwent CT scan or MRI from July 1, 2016 to July 1, 2017. Results: 736 patient files were reviewed. 385 patients (52.3%) presented with confirmed acute ischemic infarct, 93 (12.6%) had another brain lesion mimicking acute ischemia, and 258 (35.1%) had normal imaging. Acute stroke was more frequent in elderly patients with atrial fibrillation, arterial hypertension, or dysarthria or right motor impairment. Stroke mimic was associated with female patients with low vascular risk factors, low NIHSS, and patients with decreased level of consciousness or symptoms suggestive of posterior circulation. Discussion: 47.7% of all patients seen at the stroke unit did not have acute stroke lesions. Clinical assessment data have been used to provide indicators of acute stroke and stroke mimic patients, and symptoms corresponding to acute stroke and stroke mimic seem to be similar in the literature. Conclusion: Considering that the number of patients admitted for stroke treatment will increase even further with a larger therapeutic window for mechanical thrombectomy and for thrombolysis, a diagnostic decision-making algorithm for stroke patients is required in order to reinforce the suspicion of stroke indicating an urgent MRI.

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“…Både demografiske faktorer (yngre, flere kvinner) og mangel på risikofaktorer for hjerneslag (hypertensjon, hyperlipidemi, atrieflimmer og koronarsykdom) er forbundet med hjerneslagimitator som endelig diagnose, hvor mangel på risikofaktorer var den sterkeste forklaringsvariabelen i denne studien (9). I en nylig publisert artikkel, med data fra slagenheten ved Akershus universitetssykehus, ble det vist at 38 % av pasientoppholdene resulterte i andre diagnoser enn hjerneslag eller transitorisk iskemisk anfall (10). Hjerneslagimitatorgruppen var heterogen, og omtrent 27 % av pasientene hadde symptom-eller observasjonsdiagnoser.…”

Section: Hjerneslagimitatorerunclassified

Fremtidens hjerneslagdiagnostikk og hjerneslagimitatorer

Faiz¹,

Rand‐Hendriksen²,

Barra³

2018

Tidsskriftet

Self Cite

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Kashif Waqar Faiz er spesialist i nevrologi, ph.d., master i helseadministrasjon og seksjonsleder/overlege og forsker ved henholdsvis Nevroklinikken og Avdeling for helsetjenesteforskning, Akershus universitetssykehus. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KIM RAND Kim Rand er psykolog, ph.d. og seniorforsker ved Avdeling for helsetjenesteforskning, Akershus universitetssykehus. Han arbeider med matematisk modellering, helseøkonomi og livskvalitetsforskning. Forfatteren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Han har mottatt stipend fra Forskningsrådet for prosjektet Modelling treatment and rehabilitation of stroke patientssimulation to evaluate the present and plan for the future. MATHIAS BARRA Mathias Barra er ph.d. i matematisk logikk og seniorforsker ved Avdeling for helsetjenesteforskning, Akershus universitetssykehus. Han arbeider med matematisk modellering av pasientforløp, helseøkonomi, statistikk og livskvalitetsforskning. Forfatteren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Han har mottatt stipend fra Forskningsrådet for prosjektet Modelling treatment and rehabilitation of stroke patientssimulation to evaluate the present and plan for the future.

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The Burden of Stroke Mimics: Present and Future Projections

Cited by 22 publications

References 26 publications

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

Stroke-mimics in stroke-units. Evaluation after changes imposed by randomized trials

Fremtidens hjerneslagdiagnostikk og hjerneslagimitatorer

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