Abstract TP243: Telestroke or Face-to-Face Assessment for Unmask Stroke Mimic

Abstract

Background: Stroke mimic (SM) is a common diagnosis in stroke assessment in our medical emergency systems. The diagnosis of SM requires an expertise neurological exam and probably support it by radiological tests. Different frequency of SM could be reported according to different epidemiological or clinical values. The rate of stroke mimic could be different between primary telestroke exam and face-to-face evaluation in comprehensive stroke center, and also chameleon syndromes (false SM) could present differences in percentage of diagnosis. Methods: A total of 3876 stroke codes were evaluated by our team of vascular neurologist in our comprehensive stroke center (CSC) and 415 patients were evaluated by telestroke with our referenced county hospitals between January 2014 to March 2019. We analyzed the percentage of SM in this period in both types of assessment: face-to-face or telemedicine. We analyze if there are any differences in percentage of SM diagnosis, frequency of SM subtypes or delay in diagnosis according to the evaluation method. Results: The percentage of SM diagnosis was 12% in our CSC and 11.1% by telemedicine assessment. Patients with SM were significantly younger than radiological confirmed stroke (63 vs 74 years; p:0.001) and had lower NIHSS (7 vs 9; p:0.003). We found significant differences between age and main subtypes of SM (conversion, brain tumor, confusional disorders). However they didn’t present any significant differences according to evaluation method (face-to-face in CSC or telestroke). Besides, there was difference in percentage of chameleon syndrome (3,2% and 2,2% respectively) but it was no significant. Conclusions: The percentage of SM diagnosis by vascular neurologist is similar with independence of method of evaluation: on-site or telemedicine. However the percentage of chameleon syndrome could be lower by telestroke assessment.