Abstract
Background: Stroke mimics (SMs)are medical conditions that are at first considered to be of cerebrovascular
etiology but turn out to be a condition other than stroke. While many reports on SMs
have been published, there have been none from Japan. Thus, we sought to assess the
current state of SMs in a Japanese population. Methods: We collected data of patients referred with suspicion of stroke to neurosurgeons
by emergency department (ED) doctors, and we retrospectively evaluated the diagnosis
concordance rate between the ED doctors and the neurosurgeons. We also assessed the
plausible causes leading to misdiagnosis of stroke. Results: Of the 226 consecutive referrals with suspicion of stroke, only 71.7% were accurate.
Furthermore, 75% of the SMs were disorders unrelated to neurosurgery, such as psychiatric
disorders, peripheral dizziness/vertigo, and cardiovascular events. In other words,
referring those patients to neurosurgeons was inappropriate. We found that perceived
notion or premature assumption of stroke accounted for 43.8% of the stroke mimic patients
and was the most important reason for the misdiagnosis. Conclusions: This is the first report on SMs in a Japanese population. About one-third of all
referrals with suspicion of stroke made by ED doctors were inappropriate. Including
more information on stroke diagnosis in the educational program for young doctors
in Japan would be beneficial for improving the quality of the initial medical examination
of patients with suspected stroke.
Key Words
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Article info
Publication history
Published online: January 09, 2019
Accepted:
December 24,
2018
Received in revised form:
December 21,
2018
Received:
November 12,
2018
Footnotes
Finacial Disclosure: The authors has nothing to disclose.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.032
Copyright
© 2019 National Stroke Association. Published by Elsevier Inc. All rights reserved.
