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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit
Sergios Gargalas1, Robert Weeks1, Najma Khan-Bourne1
1Department of Stroke Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Background:
Some patients admitted to acute stroke units are diagnosed as stroke mimics. A minority have a functional neurological disorder ('functional mimics').
Aims:
To determine the incidence of functional stroke mimics admitted to a hyperacute stroke unit (HASU); to compare their clinical characteristics with medical mimics and stroke cases and obtain information about outcomes.
Methods:
Patients admitted to the King's College Hospital HASU between 2011 and 2012 were analysed. Data were obtained from the Stroke Improvement National Audit Programme (SINAP) database. Expert consensus diagnosis was used to classify functional mimics. Follow-up information was obtained from a retrospective case series in primary care over the year following discharge.
Results:
1165 patients were admitted to the HASU; 904 patients with stroke (77.6%), 163 medical mimics (14%) and 98 functional mimics (8.4%). Functional mimics were significantly more likely to be female (63.3%) versus 49.7% medical mimics and 45.5% stroke, and younger (mean age (SD)) 49.1 (18.8) than medical mimic (63.5 years (16.7)) and stroke cases (71 years (15.5)). Weakness and slurred speech were the commonest presentations of functional mimics and diagnostic MRI was used more often. Clinician recorded visual and speech symptoms and neglect were significantly more frequent in patients with stroke than either mimic group. Of the 68 functional mimics on whom follow-up information was obtained, 40 (59%) were referred to another service most often for a psychologically-based intervention.
Conclusions:
Functional stroke mimics are an important subgroup admitted to acute stroke services and have a distinct demographic and clinical profile. Their outcomes are poorly monitored. Services should be developed to better diagnose and manage these patients.
Insights
Functional stroke mimics, a distinct patient group, are frequently admitted to acute stroke units. Improved diagnostic and management services are needed for these patients with unique profiles.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Some patients admitted to acute stroke units are misdiagnosed with stroke, with a subset presenting functional neurological disorders, termed functional mimics.
- Functional mimics represent a distinct diagnostic challenge within hyperacute stroke unit (HASU) admissions.
Purpose of the Study:
- To determine the incidence of functional stroke mimics admitted to a hyperacute stroke unit (HASU).
- To compare the clinical characteristics of functional mimics with medical mimics and actual stroke cases.
- To gather information on the outcomes of functional stroke mimics post-discharge.
Main Methods:
- Analysis of patients admitted to King's College Hospital HASU between 2011 and 2012.
- Utilized data from the Stroke Improvement National Audit Programme (SINAP) database.
- Employed expert consensus for classifying functional mimics and retrospective case series for follow-up data.
Main Results:
- Out of 1165 HASU admissions, 8.4% were functional mimics (98 patients), compared to 14% medical mimics and 77.6% stroke cases.
- Functional mimics were predominantly female (63.3%) and younger (mean age 49.1 years) than medical mimics and stroke patients.
- Weakness and slurred speech were common presentations; 59% of functional mimics were referred for psychologically-based interventions post-discharge.
Conclusions:
- Functional stroke mimics constitute a significant patient subgroup within acute stroke services, possessing distinct demographic and clinical features.
- Current monitoring of functional mimic outcomes is inadequate, highlighting a need for improved follow-up strategies.
- Development of specialized services is crucial for the accurate diagnosis and effective management of functional stroke mimics.
