Recognising Strokes and Stroke Mimics

Question 1

What are the 3 ways we can think about stroke mimics?

Answer 1

1. Identifiable on imaging as not a stroke (e.g. Contrast enhanced CT)
2. Identifiable as stroke mimic clinically with distinct non-stroke syndrome features.
3. Identifiable clinically but features are subtle and justify further Ix.

Question 2

Give some examples of stroke mimics

Answer 2

Migrainous aura
Focal seizures
Functional neurological episodes
Syncope
Sepsis
Hypoglycaemia
BPPV

Question 3

What is a stroke mimic?

Answer 3

A non-vascular disease that presents with stroke-like symptoms, often indistinguishable from an actual stroke.

Question 4

In general terms, how do pts who present with stroke mimics differ demographically from those who present with strokes?

Answer 4

They tend to be younger, more commonly female, fewer or no risk factors for stroke, and sometimes have a FHx of psychiatric disorders.

Question 5

Why is recognising stroke mimics so important?

Answer 5

Strokes have to be treated quickly, and stroke mimics might be being given treatment such as thrombolysis that would be harmful to someone who hasn’t had a stroke.

Question 6

What kind of migraine might mimic a stroke?

Answer 6

A hemiplegic migraine i.e. pt experiences unilateral paralysis/hemiplegia

Question 7

How an we best tell if something is a stroke or not?

Answer 7

Check it fit a vascular territory, has predominantly negative symptoms, and is sudden in onset and focal.

Question 8

What does a TACS look like?

Answer 8

Hemiparesis AND Higher cortical dysfunction AND Homonymous hemianopia