Clinical features associated with medically unexplained stroke-like symptoms presenting to an acute stroke unit

Area of Science:

• Neurology
• Psychiatry
• Internal Medicine

Background:

• Symptoms without clear organic disease are frequent in secondary care, accounting for about one-third of patients.
• Medically unexplained symptoms (MUS) pose diagnostic challenges, particularly in neurology.
• Stroke-like presentations without a clear organic cause require specific investigation to differentiate from organic stroke.

Purpose of the Study:

• To investigate patients with medically unexplained stroke-like symptoms.
• To identify distinguishing features that may indicate a non-organic etiology.
• To compare clinical features and risk factors between patients with MUS and those with confirmed stroke or TIA.

Main Methods:

• Retrospective analysis of a prospectively completed stroke unit database over 11 years.
• Inclusion of patients with a discharge diagnosis of medically unexplained stroke-like symptoms.
• Age- and sex-matched controls with ischemic stroke, hemorrhagic stroke, or transient ischemic attack (TIA).
• Examination of clinical presentation, risk factors, alcohol history, marital status, and history of depression/anxiety.
• Record linkage to identify previous or subsequent admissions with other medically unexplained syndromes.
• Logistic regression to identify predictors of non-organic etiology.

Main Results:

• 1.6% of all stroke unit admissions (105 patients and controls) had medically unexplained stroke-like symptoms.
• Females constituted 62% of these patients, with a mean age of 50.3 years.
• Patients with MUS were more likely to present with headache (47% vs. 26%) and have other medically unexplained syndromes (24% vs. 11%).
• Patients with MUS were less likely to present with symptoms of vertebrobasilar dysfunction (32% vs. 61%).
• History of anxiety or depression was not significantly associated with MUS presentations.

Conclusions:

• Medically unexplained stroke-like presentations are a common phenomenon within stroke units.
• The presence of other functional somatic syndromes and headache are strong predictors of MUS.
• Absence of vertebrobasilar dysfunction symptoms is also a key indicator differentiating MUS from organic stroke.
• Further research into the specific characteristics and management of these patients is warranted.