A profile of stroke mimics in a tertiary hospital in Quezon City, Philippines

Abstract

Stroke mimics are conditions that simulate the signs and symptoms of a stroke. In patients presenting with sudden-onset neurologic deficits, laboratory tests and imaging are requested in order to distinguish an actual stroke from a stroke mimic. Our aim is to determine the proportion of stroke mimics in patients who were examined by the hospital’s Brain Attack Team from January 2014 to December 2017 and to determine the most common etiology of stroke mimics. This is a retrospective review of all patients who were assessed by the Brain Attack Team from January 1, 2014 to December 31, 2017. The diagnosis of stroke mimic was based on negative neuroimaging findings as well as laboratory test results that showed an alternate diagnosis. The proportion and most common etiologies of stroke mimics were determined. Among 1485 patients examined by our hospital's Brain Attack Team from 2014 to 2017, 448 (30.17%) were determined to be stroke mimics. The incidence of stroke mimics was higher in hospitalized patients compared to those who were examined in the emergency department. The most common etiologies were encephalopathy (n = 83, 18.52%), seizures (n = 77, 17.19%), headache (n = 31, 6.92%), and hypertensive emergency (n = 31, 6.92%). Due to the high incidence of stroke mimics and substantial cost of diagnostics, physicians should be cognizant of the symptoms of stroke mimics to be able to distinguish them from actual stroke. Early recognition of stroke mimics can reduce diagnostic costs and minimize the potential side effects of intravenous thrombolysis.