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Misdiagnosis of stroke--a computerised tomography scan study
S A Ogun1, O Oluwole, A O Ogunseyinde
1Department of Medicine, Ogun State University Teaching Hospital, Sagamu, Nigeria.
Insights
Misdiagnosis of stroke is common, with 43% of patients showing no stroke signs on CT scans. This highlights the need for better neurological evaluation and CT scans to identify treatable conditions early.
Area of Science:
- Neurology
- Radiology
Background:
- Misdiagnosis of stroke significantly impacts treatment efficacy.
- Accurate diagnosis is crucial for appropriate stroke management.
Purpose of the Study:
- To determine the frequency of stroke misdiagnosis using computed tomography (CT) brain scans.
- To evaluate the accuracy of clinical stroke diagnosis against CT findings.
Main Methods:
- Retrospective review of 156 patients admitted with suspected stroke over a five-year period (1991-1996).
- Analysis of computed tomography (CT) brain scans for neuroradiological features consistent with stroke.
- Categorization of findings into cerebral infarction, cerebral hemorrhage, and other abnormalities.
Main Results:
- Only 57% of patients had CT findings consistent with stroke (89/156).
- Of those with stroke, 66% had cerebral infarction (59/89) and 34% had cerebral hemorrhage (30/89).
- In 43% of cases (67/156), CT scans showed no cerebrovascular accident (CVA); common findings included cerebral atrophy (21/67), brain tumors (10/67), and subdural hematomas (9/67).
- A significant 13.5% (21/156) had surgically treatable conditions misdiagnosed as stroke.
Conclusions:
- A substantial proportion of stroke misdiagnoses occur, impacting patient care.
- Improved neurological evaluation and routine CT scan utilization are recommended for stroke patients.
- CT scans are vital for early identification of surgically treatable conditions in suspected stroke cases.
Abstract:
Misdiagnosis of stroke has significant implication for definitive therapy. This study assessed the frequency of misdiagnosis of stroke using computerised tomography (CT) scan of the brain. One hundred and fifty-six patients admitted over a five year period (1991-1996) with clinical features suggestive of stroke had their CT brain scan reviewed. Only 89 (57%) had neuroradiological features consistent with stroke, of which 59 (66%) had cerebral infarction while 30 (34%) had cerebral haemorrhage. In 67 (43%) of the cases, there were no features of cerebro-vascular accident (CVA) on the CT scan. In this group, cerebral atrophy was the commonest radiological abnormality (21/67), followed by brain tumor (10/67) and subdural haematoma (9/67). The CT scan was normal in 25 patients. The misdiagnosis of surgically treatable conditions in as many as 21 (13.5%) of the 156 patients calls for better neurological evaluation of patients admitted for stroke in tertiary and non-tertiary hospitals. Where available, patients with clinical diagnosis of stroke should have CT scan evaluation to ensure that patients who can be helped surgically are identified early and appropriately treated.
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