Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Jun 11:9:145-8.
doi: 10.2147/IMCRJ.S101011. eCollection 2016.

Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

María Rico  1 , Laura Martinez-Rodriguez  1 , Davinia Larrosa-Campo  1 , Sergio Calleja  1
Affiliations
Case Reports

Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

María Rico et al. Int Med Case Rep J. .

Abstract

Background: Stroke mimics may account for up to 30% of all acute stroke consultations. However, in the emergency setting, accurate diagnosis is not always possible.

Methods: Case report and review of the literature.

Results: A 73-year-old woman was admitted to the emergency department with acute aphasia and right hemiparesis. The National Institute of Health Stroke Score was 21, compatible with severe stroke, so she received thrombolysis. Laboratory testing demonstrated severe hypomagnesemia. She had been taking proton pump inhibitors for years and neuroimaging did not demonstrate signs of acute ischemic disease. After correcting the metabolic alterations with intravenous and oral supplemental magnesium, the patient was discharged asymptomatic. No further episodes have been registered to date.

Conclusion: Hypomagnesemia might cause acute neurological symptoms that could be confused with stroke. A careful history is essential for diagnosis but suspicion of stroke mimic should not prevent tPA administration.

Keywords: aphasia; hypomagnesemia; stroke; stroke mimic.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Neuroimaging in the emergency department Notes: (A) CT brain scan shows the absence of hemorrhage or previous ischemic brain lesions. (B) CT angiography demonstrating normal contrast filling of the intracranial vessels. Abbreviation: CT, computerized tomography.
Figure 2
Figure 2
CT perfusion scan during the acute phase. Notes: No asymmetries between both hemispheres are present in the cerebral blood flow (A), volume (B), or mean transit time (C) sequences. Abbreviation: CT, computerized tomography.
Figure 3
Figure 3
Post-thrombolysis 3T MRI. Notes: (A) DWI-MRI sequence shows the absence of acute damage to the brain. (B) T1-weighted MRI sequences demonstrate the presence of a small acute subarachnoid hemorrhage in the right occipital lobe (arrow), not present in the emergency CT scan upon admission (C). Abbreviations: DWI-MRI, diffusion-weighted imaging MRI; MRI, magnetic resonance imaging; CT, computerized tomography; 3T MRI, 3 tesla resolution magnetic resonance imaging..
See this image and copyright information in PMC

References

    1. Forster A, Griebe M, Wolf ME, Szabo K, Hennerici MG, Kern R. How to identify stroke mimics in patients eligible for intravenous thrombolysis? J Neurol. 2012;259(7):1347–1353. - PubMed
    1. Merino JG, Luby M, Benson RT, et al. Predictors of acute stroke mimics in 8187 patients referred to a stroke service. J Stroke Cerebrovasc Dis. 2013;22(8):7. - PMC - PubMed
    1. Tobin WO, Hentz JG, Bobrow BJ, Demaerschalk BM. Identification of stroke mimics in the emergency department setting. J Brain Dis. 2009;1:19–22. - PMC - PubMed
    1. Brunser AM, Illanes S, Lavados PM, et al. Exclusion criteria for intravenous thrombolysis in stroke mimics: an observational study. J Stroke Cerebrovasc Dis. 2013;22(7):1140–1145. - PubMed
    1. Magauran BG, Jr, Nitka M. Stroke mimics. Emerg Med Clin North Am. 2012;30(3):795–804. - PubMed

Publication types

LinkOut - more resources