Prevalence and Characterization of Stroke Mimics in a Stroke Unit

Abstract

Introduction: Stroke mimics are non-vascular disorders that
simulate the presence of stroke. Its reported prevalence varies
according to clinical differentiation, admission criteria and
resource to complementary means of diagnosis. The authors
pretend to characterize stroke mimic admitted to a stroke unit,
integrated in an internal medicine department of a university
hospital.
Material and Methods: An observational, descriptive and retrospective
study of patients over a 26-month period. Stroke mimics
were considered whenever clinical and/or radiological data supported
a non-vascular cause of the neurological deficit.
Results: From a cohort of 367 patients, with a median age of
76 years old, 12% were classified as stroke mimics. The main
diagnoses were: somatoform disorder, peripheral vertigo, metabolic
diseases, syncope, Munchausen syndrome, intracranial
tumors, epilepsy and Chiari malformations. Mimics were
generally younger, more often women, had a lower neurologic
deficit on admission, as well as lower rates of previous known
atrial fibrillation and cerebrovascular disease (p < 0.05). Vascular
risk factors were not a criterion of distinction between
mimics and stroke.
Conclusion: Contrary to what we might expect, there is a
substantial prevalence of stroke mimics within a stroke unit
(12%). The nature of these mimics, some of which require
urgent intervention, can be used to better inform emergency
clinicians and plan for alternative interventional pathways.