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Observation of Photobehavior in Chlamydomonas reinhardtii
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Stroke chameleons.

Callum M Dupre1, Richard Libman1, Samuel I Dupre2

  • 1Department of Neurology, North Shore Long Island Jewish Medical Center, New Hyde Park, New York.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|August 20, 2013
PubMed
Summary

Stroke chameleons, conditions mimicking other illnesses but actually being stroke, are often misdiagnosed. Physicians should consider stroke in patients presenting with altered mental status or hypertensive emergency.

Keywords:
Acute strokehypertensive emergencyhypertensive encephalopathypsychosisstroke mimicsyncope

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Diagnostic Accuracy

Background:

  • Stroke mimics are conditions resembling acute stroke.
  • Stroke chameleons are presentations of stroke mistaken for other conditions.
  • Recognizing stroke chameleons is crucial for timely treatment and quality care.

Purpose of the Study:

  • To identify common stroke chameleons.
  • To determine the positive predictive value (PPV) of initial diagnoses for stroke.
  • To highlight the implications of misdiagnosis on patient care.

Main Methods:

  • Retrospective chart review of stroke cases missed on initial presentation over one year.
  • Comparison of initial erroneous diagnoses with correct diagnoses.
  • Calculation of PPV for common chameleon presentations.

Main Results:

  • Ninety-four stroke chameleons were identified.
  • Common initial diagnoses included altered mental status (AMS) (31%), syncope (16%), hypertensive emergency (13%), systemic infection (11%), and acute coronary syndrome (ACS) (10%).
  • The PPV for these conditions was low: AMS (7%), syncope (4%), hypertensive emergency (8%), systemic infection (1%), and ACS (1%).

Conclusions:

  • Stroke chameleons can lead to delayed or inappropriate care.
  • Altered mental status and hypertensive emergency were the most frequent chameleon diagnoses with a notable stroke probability (7% and 8% respectively).
  • Physicians should maintain a low threshold for neuroimaging in patients with these presentations to ensure accurate stroke diagnosis and management.