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. 2021 Dec;53(1):420-436.
doi: 10.1080/07853890.2021.1890205.

Stroke mimics: incidence, aetiology, clinical features and treatment

Brian H Buck  1 , Naveed Akhtar  2 , Anas Alrohimi  1   3 , Khurshid Khan  1 , Ashfaq Shuaib  1
Affiliations

Stroke mimics: incidence, aetiology, clinical features and treatment

Brian H Buck et al. Ann Med. 2021 Dec.

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.

Keywords: MRI; Stroke; TIA; mimics; recurrence.

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Conflict of interest statement

Concept, design and draft: Brian Buck N Akhtar, A Shuaib.

Acquisition, analysis, interpretation of data, technical and administrative support: N Akhtar, Anas Alrohimi, Khurshid Khan.

Critical review: Khurshid Khan and Brain Buck.

Figures

Figure 1.
Figure 1.
Suggested approach to evaluation of acute stroke patient where mimic is suspected.
Figure 2.
Figure 2.
Patient presented with sudden onset right-sided numbness and no other deficits. Routine computed tomography (CT) was normal. A: Diffusion-weighted (1.5 T) magnetic resonance imaging (DWI-MRI) was normal. B,C: High resolution 3 T MRI (DTI and DWI-isotropic voxels) revealed left thalamus infarction.
Figure 3.
Figure 3.
80-year-old female with atrial fibrillation on apixaban. She presented with a 90-min history of sudden onset right arm and leg weakness sparing the face with normal sensation. A,B: Axial computed tomography (CT) head, CT angiogram (not included) and CT perfusion were unremarkable. Tissue plasminogen activator (tPA) was no given because the patient is on an anticoagulant. C: Diffusion-weighted magnetic resonance imaging (DWI-MRI) was normal. D,E: Sagittal and axial MRI spine revealed right posterolateral epidural haematoma, a multifocal severe spinal canal stenosis, and spinal cord oedema.
Figure 4.
Figure 4.
An 85-year-old female presented with expressive aphasia. A,B: Axial computed tomography (CT) head, CT angiogram (not included), magnetic resonance imaging (MRI) of the brain that also included diffusion-weighted imaging were unremarkable. The patient was discharged with the diagnosis of transient ischaemic attack (TIA). After discharge, the patient continued to have recurrent similar episodes. C: CT perfusion during one of her episodes demonstrated left frontal focal hyperperfusion characterized by increased cerebral blood flow (CBF), cerebral blood volume (CBV) and decreased time to drain (TTD). The patient was diagnosed with focal seizure with preserved awareness.
See this image and copyright information in PMC

References

    1. Campbell BCV, Khatri P.. Stroke. Lancet. 2020;396(10244):129–142. - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. . Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–e418. - PubMed
    1. Ali SF, Hubert GJ, Switzer JA, et al. . Validating the telestroke mimic score. Stroke. 2018;49(3):688–692. - PMC - PubMed
    1. McClelland G, Rodgers H, Flynn D, et al. . The frequency, characteristics and aetiology of stroke mimic presentations: a narrative review. Eur J Emerg Med. 2019;26(1):2–8. - PubMed
    1. Liberman AL, Prabhakaran S.. Stroke Chameleons and stroke mimics in the emergency department. Curr Neurol Neurosci Rep. 2017;17(2):3–11. - PubMed

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