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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 2/2017

01-02-2017 | Neurology of Systemic Diseases (J Biller, Section Editor)

Stroke Chameleons and Stroke Mimics in the Emergency Department

Authors: Ava L. Liberman, Shyam Prabhakaran

Published in: Current Neurology and Neuroscience Reports | Issue 2/2017

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Abstract

Purpose of Review

We discuss the frequency of stroke misdiagnosis in the emergency department (ED), identify common diagnostic pitfalls, describe strategies to reduce diagnostic error, and detail ongoing research.

Recent Findings

The National Academy of Medicine has re-defined and highlighted the importance of diagnostic errors for patient safety. 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”). Failure to diagnosis stroke can preclude time-sensitive treatments and has been associated with poor outcomes. Strategies have been developed to improve detection of posterior circulation stroke syndromes, but ongoing work is needed to reduce under-diagnosis in other atypical stroke presentations. The published rates of harm associated with stroke over-diagnosis, particularly thrombolysis of stroke mimics, remain low.

Summary

Additional strategies to improve the accuracy of stroke diagnosis should focus on rapid clinical reasoning in the time-sensitive setting of acute ischemic stroke and identifying imperfections in the healthcare system which may contribute to diagnostic error.
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Metadata
Title
Stroke Chameleons and Stroke Mimics in the Emergency Department
Authors
Ava L. Liberman
Shyam Prabhakaran
Publication date
01-02-2017
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 2/2017
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-017-0727-0

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