Functional Pseudo-Stroke Presentations in the Emergency Department at a Comprehensive Stroke Center; a 6-year Retrospective Chart Review (P2-12.009)

Abstract

<h3>Objective:</h3> Illustrate the epidemiology of functional pseudo-stroke presentations in the emergency department (ED) at a comprehensive stroke center. <h3>Background:</h3> There is paucity of literature on patients that are likely to suffer from pseudo-stroke. Few studies noted an incidence rate as high as 15% but include sparse details on demographics and common presentations. <h3>Design/Methods:</h3> Our ‘stroke-code’ database of ED stroke alerts activated at our comprehensive stroke center between 2016–2022 was reviewed. Patients with documented diagnoses categorized as ‘psychogenic’ (expert evaluation by vascular neurologists, and/or neurology residents closely supervised by attending neurologists) were selected and chart review of presentation, history and hospital course was performed. Data were de-identified and entered in a ‘pseudo-stroke database’ for descriptive analysis. <h3>Results:</h3> The mean age of pseudo-stroke patients was 52.3 (range 26–80) and 61.8% (n=21/34) were female. The most prevalent ethnicities were Black/African American (50%) and Caucasian (44.1%). 85.3% smoked tobacco and 94.1% had other medical comorbidities. Notably, 52.9% of patients had obesity (mean BMI 30.7, SD 8.6). A history of psychiatric illness was noted in 91.2% with the majority (82.4%) diagnosed with depression. 44.1% had anxiety and 38.2% had a history of substance abuse. 26.5% had a previous functional neurological disorder. The prevalent symptoms were numbness (61.8%) and left hemiparesis (58.8%). 88.2% underwent neuroimaging; 73.5% had a CT angiogram and 44.1% had MRI. 17.6% received thrombolytics, with none experiencing hemorrhagic consequences. The majority (35.3%) of patients were admitted to the stroke service, and 23.5% were discharged from the ED. <h3>Conclusions:</h3> Our study outlines the common demographics and presenting complaints of pseudo-stroke patients at a comprehensive stroke center. A majority carried a diagnosis of psychiatric illness and associated social history of smoking and substance abuse. Further study of this unique population presenting with acute stroke symptoms is needed to optimize triage of pseudo-stroke patients to the appropriate level of resource utilization. <b>Disclosure:</b> Dr. Shahab has nothing to disclose. Mr. Oliver has nothing to disclose. Dr. Ahmed has nothing to disclose. Dr. Alwahaidy has nothing to disclose. Dr. Masoud has nothing to disclose.