Journal
EUROPEAN JOURNAL OF EMERGENCY MEDICINE
Volume 26, Issue 1, Pages 2-8Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MEJ.0000000000000550
Keywords
narrative review; prehospital; stroke mimic; thrombolysis
Categories
Funding
- Stroke Association [TSA PGF 2015/01, 17RA_04]
- National Institute for Health Research [RP-PG-1211-20012]
- National Institute for Health Research [RP-PG-1211-20012] Funding Source: researchfish
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A significant proportion of patients with acute stroke symptoms have an alternative 'mimic' diagnosis. A narrative review was carried out to explore the frequency, characteristics and aetiology of stroke mimics. Prehospital and thrombolysis-treated patients were described separately. Overall, 9972 studies were identified from the initial search and 79 studies were included with a median stroke mimic rate of 19% (range: 1-64%). The prehospital median was 27% (range: 4-43%) and the thrombolysis median 10% (range: 1-25%). Seizures, migraines and psychiatric disorders are the most frequently reported causes of stroke mimics. Several characteristics are consistently associated with stroke mimics; however, they do not fully exclude the possibility of stroke. Nineteen per cent of suspected stroke patients had a mimic condition. Stroke mimics were more common with younger age and female sex. The range of mimic diagnoses, a lack of clear differentiating characteristics and the short treatment window for ischaemic stroke create challenges for early identification. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.
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