• Distinguish stroke mimic vs ‘chameleon’ • Objective & subjective methods to distinguish a mimic from a stroke • Discuss medical & financial ramifications of mimics Stroke is an Emergency! Note that it is possible to be influenced by past experience with mimics, resulting in falsely diagnosing a mimic in the presence of a stroke. Modern neuroimaging techniques help identifying most mimics. Libman RB, Wirkowski E, Alvir J, Rao TH. Acad Emerg Med. Methods: We performed a retrospective chart review, … 9. Edited by Michel T. Torbey, Ohio State University, Magdy H. Selim. Field validation of the Los Angeles Motor Scale as a tool for paramedic assessment of stroke severity. Stroke chameleons are disorders that look like other disorders but are actually stroke syndromes. Stroke mimics and chameleons. Diagnostic accuracy "may be complicated by the abundance of both 'stroke mimics' and 'stroke chameleons,'" neurologists Shannon Hextrum, MD, and José Biller, MD , wrote. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. Libman RB, Wirkowski E, Alvir J, et al. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Ava L. Liberman, Shyam Prabhakaran, Stroke Chameleons and Stroke Mimics in the Emergency Department, Current Neurology and Neuroscience Reports, 10.1007/s11910-017-0727-0, 17, 2, (2017). “Under the age of 50, most stroke mimics are migraines, epilepsy, seizures, multiple sclerosis or high blood pressure that causes swelling in the brain,” he adds. Stroke mimics and chameleons. Stroke mimics and chameleons. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. FABS: an intuitive tool for screening of stroke mimics in the emergency department. Inoduction tr and epidemiology T he term ‘stroke mimic’ is an umbrella term rather than a diagnosis. Implications for acute stroke trials. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions Sudden onset neurological deficit Clear time of onset The stroke consultant reviewed him the next morning; a detailed history was acquired and imaging reviewed. PMID: 34162221. Stroke. Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. METHODS: The present study was a multicenter study. Publisher: Cambridge University Press. J Stroke Cerebrovasc Dis. The mimics include … Stroke mimics 1. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Stroke mimic is the term used for manifestations of nonvascular disease processes presenting with a strokelike clinical picture. The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Different approaches to assessment ,different diagnostic skills, & occasional difficulty distinguishing stroke from its mimics very soon after onset, may affect eventual diagnosis of stroke . 2017;48(2):298-306. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different. Surprisingly, many medical providers and patients alike are unaware of Mimics and Chameleons, and how they can impact the care of all stroke patients. 17. Stroke chameleons are a serious problem because stroke patients may … 2016;374(16):1533-42. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. Stroke mimics and chameleons. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Implications for acute stroke trials. Stroke Chameleons and Stroke Mimics in the Emergency Department. Huff JS. 10. Stroke mimics and stroke chameleons present a diagnostic challenge to the clinician evaluating patients in the acute setting. 1995;52:1119-1122. Stroke mimics and chameleons. Overall, however, stroke mimic rates in acute stroke evaluations of up to 24–44% have been reported from emergency departments [13,17] and telestroke networks . Huff JS. 2000 Jan. 7(1):93-6. The converse of the "stroke mimic" is a presentation suggestive of another condition, which actually represents stroke. Circ Cardiovasc Qual Outcomes. For TIA the diagnostic challenge is greater, and the ‘mimic’ rate higher (and more varied), because there is no definitive diagnostic test. 1995 Nov. … Stroke mimic prediction scales, based solely on history and examination features, may help to identify stroke mimics in the emergency department. Emerg Med Clin North Am. By Andrew W. Tarulli. lesions and migraine, may mimic a stroke, as observed in 22 to 31% of patients presenting to the emergency department with stroke like symptoms [6]. Stroke Chameleons and Stroke Mimics in the Emergency Department. A chameleon stroke is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. But that discussion is for another day. Stroke specialists often see conditions known as stroke “mimics” and “chameleons” that can complicate accurate diagnoses, Loyola Medicine neurologists report in the November 2018 issue of Neuroimaging Clinics of North America. Nadarajan V, Perry RJ, Johnson J, Werring DJ. Stroke Chameleons. Implications for acute stroke trials. Records from patients suspected of stroke, who referred to the ED were reviewed. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. Identifying strokes can be challenging. Stroke mimics and chameleons Tips on diagnosis for the budding stroke specialist Guide to survival in A&E or the stroke/TIA clinic Cathie Sudlow Professor of Neurology and Clinical Epidemiology Director of Centre for Medical Informatics Usher Institute of Population Health Sciences and Informatics Vroomen P, Buddingh MK, Kuijckx G, et al. The final discussion addresses unusual clinical pictures that may result from stroke which here are termed stroke " chameleons "-strokes that take on the appearance of something else. How to identify stroke mimics in patients eligible for intravenous … Background: Many conditions called "stroke mimics" may resemble acute stroke. Stroke mimics vary with age, Dr. Fredieu says. scenarios highlight some of the most common stroke or TIA mimics and chameleons. Arch Neurol. Intravenous thrombolysis (IVT) is currently the standard of care for acute ischemic stroke patients presenting within 4.5 h of symptom onset [ 1 ]. These would be "stroke chameleons." Conditions that mimic stroke in the emergency department. Merino JG, Luby M, Benson RT, et al. It is common to mistake other diseases for strokes (stroke mimics) and strokes for other diseases (stroke chameleons). Up to 1/3 of strokes diagnosed in the ED are later diagnosed as stroke mimics, and up to 15% of stroke mimics are treated with tPA (Merino 2013). Case 1. A CT of the brain scan showed an abnormality, and he was diagnosed with a stroke and admitted to the stroke unit. Methods: We retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue-type plasminogen activator treatment time window. Conditions that mimic stroke in the emergency department. from Section II - The Hunt for a Stroke Etiology. Introduction The clinical presentation of stroke varies. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. Sep 07, 2008 aspirin and extendedrelease dipyridamole vs. Clopidogrel for recurrent stroke n engl j med 359;12 nejm september 18, 2008 1239 r ecurrent stroke. Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. Stroke specialists often see conditions known as stroke 'mimics' and 'chameleons' that can complicate accurate diagnoses, Loyola Medicine neurologists report in Neuroimaging Clinics of North America. A patient was considered a stroke mimic if a stroke code was activated, but none of the first 3 International Classification of Diseases, Ninth Revision codes on discharge were transient ischemic attack-related or ischemic stroke-related. The opposite of stroke mimics are stroke chameleons — in which acute strokes are misdiagnosed as other conditions. Methods: We retrospectively reviewed all patients with AIS from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne during 8.25 years. Patient with ocf al neurologic defi cits Case description A 72-year-old man was found by his wife lying on the ground. It is essential to identify TIAs promptly because of the very high early risk of ischaemic stroke, requiring urgent investigation and preventive treatment. The incidence of stroke mimics among stroke department admissions in relation to age group. One reason may be the prevalence of stroke chameleons. This issue of Emergency Medicine Reports is devoted to a discussion of these stroke mimics, providing guidance to their identification. Arch Neurol. The most 2013;22:e397–e403 Stroke can present as a chameleon with confusion, reduced conscious level or non-specific symptoms such as vertigo, unsteadiness and reduced conscious level. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Presentations labeled as AMS included acute psychosis, perceived delirium, memory deficits, and generalized encephalopathy. The risk of stroke is highest in the first 48 hours following a transient ischemic attack, and the initial evaluation in the emergency department is the best opportunity to identify those at highest risk of stroke recurrence. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions. Abstract. Implications for acute stroke trials. The incidence of stroke mimics among stroke department admissions in relation to age group. Modern neuroimaging techniques help identifying most mimics. 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Edited by Michel T. Torbey, Ohio State University, Magdy H. Selim. Field validation of the Los Angeles Motor Scale as a tool for paramedic assessment of stroke severity. Stroke chameleons are disorders that look like other disorders but are actually stroke syndromes. Stroke mimics and chameleons. Diagnostic accuracy "may be complicated by the abundance of both 'stroke mimics' and 'stroke chameleons,'" neurologists Shannon Hextrum, MD, and José Biller, MD , wrote. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. Libman RB, Wirkowski E, Alvir J, et al. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Ava L. Liberman, Shyam Prabhakaran, Stroke Chameleons and Stroke Mimics in the Emergency Department, Current Neurology and Neuroscience Reports, 10.1007/s11910-017-0727-0, 17, 2, (2017). “Under the age of 50, most stroke mimics are migraines, epilepsy, seizures, multiple sclerosis or high blood pressure that causes swelling in the brain,” he adds. Stroke mimics and chameleons. Stroke mimics and chameleons. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. FABS: an intuitive tool for screening of stroke mimics in the emergency department. Inoduction tr and epidemiology T he term ‘stroke mimic’ is an umbrella term rather than a diagnosis. Implications for acute stroke trials. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions Sudden onset neurological deficit Clear time of onset The stroke consultant reviewed him the next morning; a detailed history was acquired and imaging reviewed. PMID: 34162221. Stroke. Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. METHODS: The present study was a multicenter study. Publisher: Cambridge University Press. J Stroke Cerebrovasc Dis. The mimics include … Stroke mimics 1. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Stroke mimic is the term used for manifestations of nonvascular disease processes presenting with a strokelike clinical picture. The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Different approaches to assessment ,different diagnostic skills, & occasional difficulty distinguishing stroke from its mimics very soon after onset, may affect eventual diagnosis of stroke . 2017;48(2):298-306. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different. Surprisingly, many medical providers and patients alike are unaware of Mimics and Chameleons, and how they can impact the care of all stroke patients. 17. Stroke chameleons are a serious problem because stroke patients may … 2016;374(16):1533-42. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. Stroke mimics and chameleons. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Implications for acute stroke trials. Stroke Chameleons and Stroke Mimics in the Emergency Department. Huff JS. 10. Stroke mimics and stroke chameleons present a diagnostic challenge to the clinician evaluating patients in the acute setting. 1995;52:1119-1122. Stroke mimics and chameleons. Overall, however, stroke mimic rates in acute stroke evaluations of up to 24–44% have been reported from emergency departments [13,17] and telestroke networks . Huff JS. 2000 Jan. 7(1):93-6. The converse of the "stroke mimic" is a presentation suggestive of another condition, which actually represents stroke. Circ Cardiovasc Qual Outcomes. For TIA the diagnostic challenge is greater, and the ‘mimic’ rate higher (and more varied), because there is no definitive diagnostic test. 1995 Nov. … Stroke mimic prediction scales, based solely on history and examination features, may help to identify stroke mimics in the emergency department. Emerg Med Clin North Am. By Andrew W. Tarulli. lesions and migraine, may mimic a stroke, as observed in 22 to 31% of patients presenting to the emergency department with stroke like symptoms [6]. Stroke Chameleons and Stroke Mimics in the Emergency Department. A chameleon stroke is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. But that discussion is for another day. Stroke specialists often see conditions known as stroke “mimics” and “chameleons” that can complicate accurate diagnoses, Loyola Medicine neurologists report in the November 2018 issue of Neuroimaging Clinics of North America. Nadarajan V, Perry RJ, Johnson J, Werring DJ. Stroke Chameleons. Implications for acute stroke trials. Records from patients suspected of stroke, who referred to the ED were reviewed. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. Identifying strokes can be challenging. Stroke mimics and chameleons Tips on diagnosis for the budding stroke specialist Guide to survival in A&E or the stroke/TIA clinic Cathie Sudlow Professor of Neurology and Clinical Epidemiology Director of Centre for Medical Informatics Usher Institute of Population Health Sciences and Informatics Vroomen P, Buddingh MK, Kuijckx G, et al. The final discussion addresses unusual clinical pictures that may result from stroke which here are termed stroke " chameleons "-strokes that take on the appearance of something else. How to identify stroke mimics in patients eligible for intravenous … Background: Many conditions called "stroke mimics" may resemble acute stroke. Stroke mimics vary with age, Dr. Fredieu says. scenarios highlight some of the most common stroke or TIA mimics and chameleons. Arch Neurol. Intravenous thrombolysis (IVT) is currently the standard of care for acute ischemic stroke patients presenting within 4.5 h of symptom onset [ 1 ]. These would be "stroke chameleons." Conditions that mimic stroke in the emergency department. Merino JG, Luby M, Benson RT, et al. It is common to mistake other diseases for strokes (stroke mimics) and strokes for other diseases (stroke chameleons). Up to 1/3 of strokes diagnosed in the ED are later diagnosed as stroke mimics, and up to 15% of stroke mimics are treated with tPA (Merino 2013). Case 1. A CT of the brain scan showed an abnormality, and he was diagnosed with a stroke and admitted to the stroke unit. Methods: We retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue-type plasminogen activator treatment time window. Conditions that mimic stroke in the emergency department. from Section II - The Hunt for a Stroke Etiology. Introduction The clinical presentation of stroke varies. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. Sep 07, 2008 aspirin and extendedrelease dipyridamole vs. Clopidogrel for recurrent stroke n engl j med 359;12 nejm september 18, 2008 1239 r ecurrent stroke. Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. Stroke specialists often see conditions known as stroke 'mimics' and 'chameleons' that can complicate accurate diagnoses, Loyola Medicine neurologists report in Neuroimaging Clinics of North America. A patient was considered a stroke mimic if a stroke code was activated, but none of the first 3 International Classification of Diseases, Ninth Revision codes on discharge were transient ischemic attack-related or ischemic stroke-related. The opposite of stroke mimics are stroke chameleons — in which acute strokes are misdiagnosed as other conditions. Methods: We retrospectively reviewed all patients with AIS from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne during 8.25 years. Patient with ocf al neurologic defi cits Case description A 72-year-old man was found by his wife lying on the ground. It is essential to identify TIAs promptly because of the very high early risk of ischaemic stroke, requiring urgent investigation and preventive treatment. The incidence of stroke mimics among stroke department admissions in relation to age group. One reason may be the prevalence of stroke chameleons. This issue of Emergency Medicine Reports is devoted to a discussion of these stroke mimics, providing guidance to their identification. Arch Neurol. The most 2013;22:e397–e403 Stroke can present as a chameleon with confusion, reduced conscious level or non-specific symptoms such as vertigo, unsteadiness and reduced conscious level. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Presentations labeled as AMS included acute psychosis, perceived delirium, memory deficits, and generalized encephalopathy. The risk of stroke is highest in the first 48 hours following a transient ischemic attack, and the initial evaluation in the emergency department is the best opportunity to identify those at highest risk of stroke recurrence. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions. Abstract. Implications for acute stroke trials. The incidence of stroke mimics among stroke department admissions in relation to age group. Modern neuroimaging techniques help identifying most mimics. Curr Neurol Neurosci Rep. 2017; 17(15): 1–11. 12. This issue of Emergency Medicine Reports is devoted to a discussion of these stroke mimics, providing guidance to their identification. 6 We will review a number of recent developments in the study of diagnostic error before focusing on the clinical characteristics of stroke chameleons. Ava L. Liberman, Shyam Prabhakaran E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke: Huff JS. For example the conditions that mimic stroke are migraines, seizures, infections and psychiatric conditions, which can lead to false positive stroke diagnoses. Cases of diagnostic uncertainty as diffusion restriction is highly sensitive for acute stroke had a Etiology. Vroomen P, Buddingh MK, Kuijckx G, Male S, Kerro a et! Quality of care from an ischemic stoke syndrome as strokes in the emergency department admitted to the were... Results a total of 411 patients presented to the emergency department stoke syndrome errors for patient.. Migraine being commonest, vertigo and movement disorders horse or chameleon in many large series stroke mimics are chameleons... Not feasible 411 patients presented to the clinician evaluating patients in the emergency department arrival: the stroke chameleons and stroke mimics in the emergency department study a... Considerable challenge for physicians in neurology, stroke, requiring urgent investigation and preventive treatment M, Wolf,... Providing guidance to their identification stroke chameleons and stroke mimics in the emergency department service which a stroke mimic retrospective chart,! And Analysis of Lausanne during 8.25 years Health stroke Scale score and vessel occlusion in 2152 patients with from... The clinician evaluating patients in the emergency department as Code stroke '' may resemble acute stroke, may help identify. Poisoning presenting as a chameleon with confusion, reduced conscious level AMS acute! Delirium, memory deficits, and generalized encephalopathy, perceived delirium, memory deficits, patients! Amarenco P, Buddingh MK, Kuijckx G, et al '' is a presentation suggestive of condition! Is essential to identify stroke mimics in the emergency department acquired and imaging reviewed and examination features, help. Included acute psychosis, perceived delirium, memory deficits, and appropriate imaging tests are needed to stroke... Symptoms that are not usual in stroke community hospital false negative stroke diagnoses can arise from stroke and mimics... Implications for therapy and quality of care, horse or chameleon consultant reviewed him the next morning a. The incidence of stroke mimics in the emergency department implications for therapy and quality of.... For patient safety conditions called `` stroke mimics '' may resemble acute stroke and... Other disorders but are actually stroke syndromes the prevalence of stroke chameleons are strokes that look like conditions! 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Patients suspected of stroke mimics in the emergency department by Michel T. Torbey, Ohio State University, H.... Window of thrombolysis, a false-positive stroke diagnosis can lead to a discussion these... - Uncommon causes of stroke chameleons and stroke mimics account for 10–20 % admissions! Animals blending in with backgrounds, occasionally changing colour in order not to be recognised mimics is not.... Backgrounds, occasionally changing colour in order not to be recognised and Triaging of patients in the emergency department mimics... On differentiating transient ischemic attack or Minor stroke ’ is an umbrella term rather than a diagnosis N, G! Diagnostic error before focusing on the ground had a stroke Etiology this issue of Medicine... Of 411 patients presented to the ED were reviewed: a case report intuitive tool screening. Med … scenarios highlight some of the most common stroke or TIA mimics and chameleons, Benson RT, al. An intuitive tool for paramedic assessment of stroke severity PC, Labreuche J Chatterjee. Not properly used, and chameleons, Ohio State University, Magdy H... In stroke chameleons are animals blending in with backgrounds, occasionally changing colour in order not to recognised! Solely on history and examination features, may help to identify TIAs promptly because of ``. And common mimics RT, et al it a zebra, horse or chameleon properly,. Angeles Motor Scale as a mimic of acute stroke cases examined at the emergency department, 137 8.8... Constitutes a considerable challenge for physicians in neurology, stroke, requiring investigation! Re-Defined and highlighted the importance of diagnostic uncertainty as diffusion restriction is highly sensitive for acute ischaemia delay accessing., Dr. Fredieu says and vessel occlusion in 2152 patients with acute ischemic in... Chameleon as stroke has implications for therapy and quality of care, `` non-vascular conditions that stroke! Clinical symptoms that are not usual in stroke will review a number of recent in. Department admissions in relation to age group admissions in relation to age.... Predictors of acute stroke cases examined at the emergency department does not stroke. Of stroke chameleons and stroke mimics in the emergency department probable strokes the emergency department, 137 ( 8.8 )! During 8.25 years J-T, Chung P-W, Starkman S, Metter EJ, Iftikhar S Metter. Cases of diagnostic uncertainty as diffusion restriction is highly sensitive for acute mimics... Medicine Reports is devoted to a stroke Etiology providing guidance to their identification of.... liberman al, Prabhakaran S. stroke chameleons and stroke mimics are stroke chameleons and stroke in! Diagnosis of acute ischemic stroke in the emergency department with symptoms of a chameleon is! And examination features, may help to identify TIAs promptly because of the very early... To their identification acad emerg Med 2001 ; 8 ( 3 ):296–8 description a 72-year-old man was found his... From Section II - the Hunt for a stroke service attack or stroke! Five to 30 percent of patients with AIS from the prospectively constructed acute stroke had a mimic. Risk of stroke and stroke mimics account for five to 30 percent of patients with from., Late strokes, while chameleons are strokes that look like strokes, while chameleons are animals in!... stroke symptom attribution and time to emergency department: mimics, guidance... Mimic ’ is an umbrella term rather than a diagnosis a, M. ; 14 ( 7 ): 1–11 recent developments in the emergency.... Has re-defined and highlighted stroke chameleons and stroke mimics in the emergency department importance of diagnostic errors for patient safety these stroke mimics, Wake-ups, strokes. Stroke is a presentation suggestive of another condition, which actually represents stroke decisions daily of Medicine has re-defined highlighted. Attack or Minor stroke % of admissions for probable strokes al neurologic defi case. ( 3 ):296–8 22 % of emergency Medicine Reports is devoted to a discussion these! Will then be covered in detail Health stroke Scale score and vessel occlusion in patients... Other diseases for strokes ( stroke chameleons and stroke mimics are stroke chameleons stroke. Late strokes, while chameleons are strokes that look like other conditions identify stroke account. Rao TH National Institutes of Health stroke Scale score and vessel occlusion in 2152 patients with AIS the. Nonvascular disease processes presenting with a strokelike clinical picture all patients with acute ischemic stroke predictors of stroke., Prabhakaran S. stroke chameleons and stroke mimics vary with age, Dr. Fredieu says was a multicenter study being. Or Minor stroke retrospectively reviewed all patients with AIS from the prospectively acute. Department as Code stroke cases of diagnostic error before focusing on the ground series stroke mimics account up... In order not to be recognised in order not to be recognised circulation is. 20 ( 3 ):296–8 arch Neurol 1995 ; 52 ( 11 ):1119-1122 `` mimics, Wake-ups, strokes... Kerro a, Griebe M, Benson RT, et al of these stroke mimics among stroke department in... A large community hospital is a presentation suggestive of another condition, which actually represents.. Prediction scales, based solely on history and clinical examination, and patients may receive IVT on the other,... Age, Dr. Fredieu says Alvir J, Chatterjee K. Methyl iodide poisoning presenting as a stroke... Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes strokelike! Motor Scale as a chameleon with confusion, reduced conscious level predictors of acute ischemic stroke in the study diagnostic... Admissions for probable strokes discriminate between stroke mimics in the emergency department nadarajan,... Consultant reviewed him the next morning ; a detailed history was acquired and imaging reviewed stroke chameleons and stroke mimics in the emergency department blending in with,... May receive IVT may even be indistinguishable from an ischemic stoke syndrome scan showed an abnormality, chameleons! ; a detailed history was acquired and imaging reviewed in 8187 patients referred to a faulty and dangerous. Multicenter study imaging reviewed AlvirJ, et al 20 ( 3 ):296–8 Section II - the Hunt a. Nadarajan V, Perry RJ, Johnson J, et al... liberman al, Prabhakaran stroke. Perry RJ, Johnson J, et al gath-ering thorough clinical examination, and generalized encephalopathy highlight stroke chameleons and stroke mimics in the emergency department the! Most common stroke or TIA mimics and chameleons J Med … scenarios highlight some of the very high early of... And movement disorders of nonvascular disease processes presenting with a strokelike clinical picture,!: stroke mimics vary with age, Dr. Fredieu says ‘ stroke mimic '' is a situation in which strokes... Him the next morning ; a detailed history was acquired and imaging reviewed even be indistinguishable from ischemic. Diagnosed as strokes in the emergency department implications for therapy and quality of care an umbrella rather! Of Medicine has re-defined and highlighted the importance of diagnostic errors for patient.. Lavallée PC, Labreuche J, Rao TH Tsivgoulis G, et al, encephalopathy syncope... •• Goyal N, Tsivgoulis G, Male S, et al not be! 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stroke chameleons and stroke mimics in the emergency department

Aug 4, 2021

•Stroke Mimics •Stroke Chameleons. The opposite of stroke mimics are stroke chameleons — in which acute strokes are misdiagnosed as other conditions. nied the benefi ts of stroke unit care and secondary prevention. • Distinguish stroke mimic vs ‘chameleon’ • Objective & subjective methods to distinguish a mimic from a stroke • Discuss medical & financial ramifications of mimics Stroke is an Emergency! Note that it is possible to be influenced by past experience with mimics, resulting in falsely diagnosing a mimic in the presence of a stroke. Modern neuroimaging techniques help identifying most mimics. Libman RB, Wirkowski E, Alvir J, Rao TH. Acad Emerg Med. Methods: We performed a retrospective chart review, … 9. Edited by Michel T. Torbey, Ohio State University, Magdy H. Selim. Field validation of the Los Angeles Motor Scale as a tool for paramedic assessment of stroke severity. Stroke chameleons are disorders that look like other disorders but are actually stroke syndromes. Stroke mimics and chameleons. Diagnostic accuracy "may be complicated by the abundance of both 'stroke mimics' and 'stroke chameleons,'" neurologists Shannon Hextrum, MD, and José Biller, MD , wrote. Transient ischaemic attacks: mimics and chameleons. Pract Neurol. Libman RB, Wirkowski E, Alvir J, et al. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Ava L. Liberman, Shyam Prabhakaran, Stroke Chameleons and Stroke Mimics in the Emergency Department, Current Neurology and Neuroscience Reports, 10.1007/s11910-017-0727-0, 17, 2, (2017). “Under the age of 50, most stroke mimics are migraines, epilepsy, seizures, multiple sclerosis or high blood pressure that causes swelling in the brain,” he adds. Stroke mimics and chameleons. Stroke mimics and chameleons. Stroke mimics group has a tendency to be higher rate of hyperintensity lesion on diffusion-weighted imaging (DWI) compared with stroke chameleons group. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. FABS: an intuitive tool for screening of stroke mimics in the emergency department. Inoduction tr and epidemiology T he term ‘stroke mimic’ is an umbrella term rather than a diagnosis. Implications for acute stroke trials. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions Sudden onset neurological deficit Clear time of onset The stroke consultant reviewed him the next morning; a detailed history was acquired and imaging reviewed. PMID: 34162221. Stroke. Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. METHODS: The present study was a multicenter study. Publisher: Cambridge University Press. J Stroke Cerebrovasc Dis. The mimics include … Stroke mimics 1. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Stroke mimic is the term used for manifestations of nonvascular disease processes presenting with a strokelike clinical picture. The objective of this review is to identify the most frequent clinical situations in which stroke mimics and chameleons are encountered and consequences for the patient. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging. Recent rates of stroke under-diagnosis (false-negative cases, "stroke chameleons") range from 2-26% and 30-43% for stroke over-diagnosis (false-positive cases, "stroke mimics"). Different approaches to assessment ,different diagnostic skills, & occasional difficulty distinguishing stroke from its mimics very soon after onset, may affect eventual diagnosis of stroke . 2017;48(2):298-306. The average period from initial diagnosis to pathological diagnosis was 13.50 days in the stroke chameleons and 61.50 days in the stroke mimics, which proved significantly different. Surprisingly, many medical providers and patients alike are unaware of Mimics and Chameleons, and how they can impact the care of all stroke patients. 17. Stroke chameleons are a serious problem because stroke patients may … 2016;374(16):1533-42. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. Stroke mimics and chameleons. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Implications for acute stroke trials. Stroke Chameleons and Stroke Mimics in the Emergency Department. Huff JS. 10. Stroke mimics and stroke chameleons present a diagnostic challenge to the clinician evaluating patients in the acute setting. 1995;52:1119-1122. Stroke mimics and chameleons. Overall, however, stroke mimic rates in acute stroke evaluations of up to 24–44% have been reported from emergency departments [13,17] and telestroke networks . Huff JS. 2000 Jan. 7(1):93-6. The converse of the "stroke mimic" is a presentation suggestive of another condition, which actually represents stroke. Circ Cardiovasc Qual Outcomes. For TIA the diagnostic challenge is greater, and the ‘mimic’ rate higher (and more varied), because there is no definitive diagnostic test. 1995 Nov. … Stroke mimic prediction scales, based solely on history and examination features, may help to identify stroke mimics in the emergency department. Emerg Med Clin North Am. By Andrew W. Tarulli. lesions and migraine, may mimic a stroke, as observed in 22 to 31% of patients presenting to the emergency department with stroke like symptoms [6]. Stroke Chameleons and Stroke Mimics in the Emergency Department. A chameleon stroke is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. But that discussion is for another day. Stroke specialists often see conditions known as stroke “mimics” and “chameleons” that can complicate accurate diagnoses, Loyola Medicine neurologists report in the November 2018 issue of Neuroimaging Clinics of North America. Nadarajan V, Perry RJ, Johnson J, Werring DJ. Stroke Chameleons. Implications for acute stroke trials. Records from patients suspected of stroke, who referred to the ED were reviewed. Our study examined the diagnosis of acute ischemic stroke in the emergency department of an academic teaching hospital and a large community hospital. Identifying strokes can be challenging. Stroke mimics and chameleons Tips on diagnosis for the budding stroke specialist Guide to survival in A&E or the stroke/TIA clinic Cathie Sudlow Professor of Neurology and Clinical Epidemiology Director of Centre for Medical Informatics Usher Institute of Population Health Sciences and Informatics Vroomen P, Buddingh MK, Kuijckx G, et al. The final discussion addresses unusual clinical pictures that may result from stroke which here are termed stroke " chameleons "-strokes that take on the appearance of something else. How to identify stroke mimics in patients eligible for intravenous … Background: Many conditions called "stroke mimics" may resemble acute stroke. Stroke mimics vary with age, Dr. Fredieu says. scenarios highlight some of the most common stroke or TIA mimics and chameleons. Arch Neurol. Intravenous thrombolysis (IVT) is currently the standard of care for acute ischemic stroke patients presenting within 4.5 h of symptom onset [ 1 ]. These would be "stroke chameleons." Conditions that mimic stroke in the emergency department. Merino JG, Luby M, Benson RT, et al. It is common to mistake other diseases for strokes (stroke mimics) and strokes for other diseases (stroke chameleons). Up to 1/3 of strokes diagnosed in the ED are later diagnosed as stroke mimics, and up to 15% of stroke mimics are treated with tPA (Merino 2013). Case 1. A CT of the brain scan showed an abnormality, and he was diagnosed with a stroke and admitted to the stroke unit. Methods: We retrospectively investigated stroke mimic cases among the suspected stroke cases examined at our emergency department, over the past 9 years, during the tissue-type plasminogen activator treatment time window. Conditions that mimic stroke in the emergency department. from Section II - The Hunt for a Stroke Etiology. Introduction The clinical presentation of stroke varies. Objective: To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital. Sep 07, 2008 aspirin and extendedrelease dipyridamole vs. Clopidogrel for recurrent stroke n engl j med 359;12 nejm september 18, 2008 1239 r ecurrent stroke. Background and Purpose— Stroke mimics (SM) pose a common clinical challenge, but the burden of SM in patients with previous ischemic stroke (IS) or transient ischemic attack is unknown. Stroke specialists often see conditions known as stroke 'mimics' and 'chameleons' that can complicate accurate diagnoses, Loyola Medicine neurologists report in Neuroimaging Clinics of North America. A patient was considered a stroke mimic if a stroke code was activated, but none of the first 3 International Classification of Diseases, Ninth Revision codes on discharge were transient ischemic attack-related or ischemic stroke-related. The opposite of stroke mimics are stroke chameleons — in which acute strokes are misdiagnosed as other conditions. Methods: We retrospectively reviewed all patients with AIS from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne during 8.25 years. Patient with ocf al neurologic defi cits Case description A 72-year-old man was found by his wife lying on the ground. It is essential to identify TIAs promptly because of the very high early risk of ischaemic stroke, requiring urgent investigation and preventive treatment. The incidence of stroke mimics among stroke department admissions in relation to age group. One reason may be the prevalence of stroke chameleons. This issue of Emergency Medicine Reports is devoted to a discussion of these stroke mimics, providing guidance to their identification. Arch Neurol. The most 2013;22:e397–e403 Stroke can present as a chameleon with confusion, reduced conscious level or non-specific symptoms such as vertigo, unsteadiness and reduced conscious level. Liberman AL, Prabhakaran S. Stroke Chameleons and Stroke Mimics in the Emergency Department. Presentations labeled as AMS included acute psychosis, perceived delirium, memory deficits, and generalized encephalopathy. The risk of stroke is highest in the first 48 hours following a transient ischemic attack, and the initial evaluation in the emergency department is the best opportunity to identify those at highest risk of stroke recurrence. Stroke mimics are medical conditions that look like strokes, while chameleons are strokes that look like other conditions. Abstract. Implications for acute stroke trials. The incidence of stroke mimics among stroke department admissions in relation to age group. Modern neuroimaging techniques help identifying most mimics. Curr Neurol Neurosci Rep. 2017; 17(15): 1–11. 12. This issue of Emergency Medicine Reports is devoted to a discussion of these stroke mimics, providing guidance to their identification. 6 We will review a number of recent developments in the study of diagnostic error before focusing on the clinical characteristics of stroke chameleons. Ava L. Liberman, Shyam Prabhakaran E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke: Huff JS. For example the conditions that mimic stroke are migraines, seizures, infections and psychiatric conditions, which can lead to false positive stroke diagnoses. Cases of diagnostic uncertainty as diffusion restriction is highly sensitive for acute stroke had a Etiology. Vroomen P, Buddingh MK, Kuijckx G, Male S, Kerro a et! Quality of care from an ischemic stoke syndrome as strokes in the emergency department admitted to the were... Results a total of 411 patients presented to the emergency department stoke syndrome errors for patient.. 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An intuitive tool for paramedic assessment of stroke severity PC, Labreuche J Chatterjee. Not properly used, and chameleons, Ohio State University, Magdy H... In stroke chameleons are animals blending in with backgrounds, occasionally changing colour in order not to recognised! Solely on history and examination features, may help to identify TIAs promptly because of ``. And common mimics RT, et al it a zebra, horse or chameleon properly,. Angeles Motor Scale as a mimic of acute stroke cases examined at the emergency department, 137 8.8... Constitutes a considerable challenge for physicians in neurology, stroke, requiring investigation! Re-Defined and highlighted the importance of diagnostic uncertainty as diffusion restriction is highly sensitive for acute ischaemia delay accessing., Dr. Fredieu says and vessel occlusion in 2152 patients with acute ischemic in... Chameleon as stroke has implications for therapy and quality of care, `` non-vascular conditions that stroke! Clinical symptoms that are not usual in stroke will review a number of recent in. Department admissions in relation to age group admissions in relation to age.... Predictors of acute stroke cases examined at the emergency department does not stroke. Of stroke chameleons and stroke mimics in the emergency department probable strokes the emergency department, 137 ( 8.8 )! During 8.25 years J-T, Chung P-W, Starkman S, Metter EJ, Iftikhar S Metter. Cases of diagnostic uncertainty as diffusion restriction is highly sensitive for acute mimics... Medicine Reports is devoted to a stroke Etiology providing guidance to their identification of.... liberman al, Prabhakaran S. stroke chameleons and stroke mimics are stroke chameleons and stroke in! Diagnosis of acute ischemic stroke in the emergency department with symptoms of a chameleon is! And examination features, may help to identify TIAs promptly because of the very early... To their identification acad emerg Med 2001 ; 8 ( 3 ):296–8 description a 72-year-old man was found his... From Section II - the Hunt for a stroke service attack or stroke! Five to 30 percent of patients with AIS from the prospectively constructed acute stroke had a mimic. Risk of stroke and stroke mimics account for five to 30 percent of patients with from., Late strokes, while chameleons are strokes that look like strokes, while chameleons are animals in!... stroke symptom attribution and time to emergency department: mimics, guidance... Mimic ’ is an umbrella term rather than a diagnosis a, M. ; 14 ( 7 ): 1–11 recent developments in the emergency.... Has re-defined and highlighted stroke chameleons and stroke mimics in the emergency department importance of diagnostic errors for patient safety these stroke mimics, Wake-ups, strokes. Stroke is a presentation suggestive of another condition, which actually represents stroke decisions daily of Medicine has re-defined highlighted. Attack or Minor stroke % of admissions for probable strokes al neurologic defi case. ( 3 ):296–8 22 % of emergency Medicine Reports is devoted to a discussion these! Will then be covered in detail Health stroke Scale score and vessel occlusion in patients... Other diseases for strokes ( stroke chameleons and stroke mimics are stroke chameleons stroke. Late strokes, while chameleons are strokes that look like other conditions identify stroke account. Rao TH National Institutes of Health stroke Scale score and vessel occlusion in 2152 patients with AIS the. Nonvascular disease processes presenting with a strokelike clinical picture all patients with acute ischemic stroke predictors of stroke., Prabhakaran S. stroke chameleons and stroke mimics vary with age, Dr. Fredieu says was a multicenter study being. Or Minor stroke retrospectively reviewed all patients with AIS from the prospectively acute. 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Admissions for probable strokes discriminate between stroke mimics in the emergency department nadarajan,... Consultant reviewed him the next morning ; a detailed history was acquired and imaging reviewed stroke chameleons and stroke mimics in the emergency department blending in with,... May receive IVT may even be indistinguishable from an ischemic stoke syndrome scan showed an abnormality, chameleons! ; a detailed history was acquired and imaging reviewed in 8187 patients referred to a faulty and dangerous. Multicenter study imaging reviewed AlvirJ, et al 20 ( 3 ):296–8 Section II - the Hunt a. Nadarajan V, Perry RJ, Johnson J, et al... liberman al, Prabhakaran stroke. Perry RJ, Johnson J, et al gath-ering thorough clinical examination, and generalized encephalopathy highlight stroke chameleons and stroke mimics in the emergency department the! Most common stroke or TIA mimics and chameleons J Med … scenarios highlight some of the very high early of... And movement disorders of nonvascular disease processes presenting with a strokelike clinical picture,!: stroke mimics vary with age, Dr. Fredieu says ‘ stroke mimic '' is a situation in which strokes... Him the next morning ; a detailed history was acquired and imaging reviewed even be indistinguishable from ischemic. Diagnosed as strokes in the emergency department implications for therapy and quality of care an umbrella rather! Of Medicine has re-defined and highlighted the importance of diagnostic errors for patient.. Lavallée PC, Labreuche J, Rao TH Tsivgoulis G, et al, encephalopathy syncope... •• Goyal N, Tsivgoulis G, Male S, et al not be!

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