Original ArticlePredictors of Acute Stroke Mimics in 8187 Patients Referred to a Stroke Service
Introduction
Stroke teams are often asked to see patients who have an abrupt onset of a neurological deficit—and, thus, possibly an ischemic or hemorrhagic stroke—but in whom the final diagnosis is not a cerebrovascular event.1, 2 Patients without a cerebrovascular etiology for their symptoms are considered to have a stroke mimic, and several small studies report that as many as 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; potential etiologies include subdural hematoma, migraine, seizures, tumors, infections, multiple sclerosis, delirium, peripheral nerve injuries, and conversion disorders.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Several studies have evaluated the stroke mimic rate in different settings and have identified clinical and imaging features associated with a final diagnosis of stroke mimic, including clinical symptoms, vital signs, neurological signs, stroke severity, and even neurological impairment at discharge.3, 7, 10, 11, 12, 13, 14 Most of these factors, however, cannot be easily ascertained by the referring physician, often the emergency department (ED) doctor, before calling the stroke team. The purpose of this study was to answer 2 questions: What proportion of patients who are seen by an acute stroke team have a stroke mimic? What variables, if any, that are known by a referring physician before calling the stroke team (demographics, acuity, and medical history) can predict whether a patient has a stroke mimic? The answers to these questions may serve as a benchmark when assessing stroke team consult and response rates and may help determine the best allocation of a stroke team’s human resources.
Section snippets
Patients
This is an analysis of data from consecutive patients referred for evaluation of suspected stroke to the National Institutes of Health (NIH) Stroke Program at 2 hospitals in the Washington, DC, metropolitan area—Suburban Hospital (SH) and Medstar Washington Hospital Center (WHC)—between January 1, 2001, and December 31, 2010. The National Institute of Neurological Disorders and Stroke (NINDS) Intramural Stroke Branch established an NIH Stroke Program at these hospitals to conduct acute stroke
Results
Over a 10-year period, the NIH Stroke Team evaluated 8194 patients in person: 5066 (62%) had definite, probable, or possible AICS, 667 (8%) had an intracranial hemorrhage, and 2454 (30%) had a noncerebrovascular etiology for the symptoms—a stroke mimic. In 7 patients, the diagnosis was not recorded in the database. The analyses in this study are limited to the 8187 patients in whom the diagnosis (AICS, hemorrhagic stroke, or stroke mimic) was known. The NIH Stroke Team saw 4587 patients at SH
Discussion
In one third of the patients with suspected stroke seen acutely by a stroke team at 2 hospitals serving a multiracial and socioeconomically diverse population over 10 years, the presenting symptoms were because of conditions other than a cerebrovascular event (ie, they had a stroke mimic). Several patient characteristics that the referring physician can ascertain before calling the stroke team were associated with increased odds of having a stroke mimic, including demographic information,
Acknowledgment
We would like to acknowledge the assistance of the NIH Stroke Teams at SH and Washington Hospital Center over the past 10 years in the performance of this study.
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Cited by (0)
The Division of Intramural Research of the National Institute of Neurological Disorders and Stroke of the National Institutes of Health supported this research.
Conflict of interest: The authors do not have any relevant conflict of interest to report.