Stroke Mimics in a Stroke Care Pathway Based on MRI Screening

Area of Science:

• Neurology
• Emergency Medicine
• Diagnostic Imaging

Background:

• Stroke care pathways have evolved since the introduction of tissue plasminogen activator for acute ischemic stroke (IS).
• Analyzing stroke mimics (SM) is essential for optimizing these pathways.
• This study prospectively evaluated SM characteristics within a dedicated stroke care pathway.

Purpose of the Study:

• To analyze the characteristics of stroke mimics (SM) in patients managed within a specialized stroke care pathway.
• To assess the diagnostic utility of brain MRI in differentiating SM from neurovascular diseases (NVD).
• To identify clinical features associated with SM versus NVD.

Main Methods:

• Prospective observational study of consecutive patients admitted to a code stroke pathway over 1 year.
• Inclusion criteria: sudden onset neurological deficit within 4.5 hours, direct MRI site arrival.
• Evaluations included clinical neurological assessment, brain MRI with MRA, and FAST score calculation. Final diagnosis classified as NVD or SM.

Main Results:

• Out of 1,361 patients, 38% (n=521) were classified as SM, while 62% (n=840) had NVD (including IS, TIAs, hemorrhages).
• Frequent SM diagnoses included headaches, psychological disorders, peripheral vertigo, and epilepsy.
• SM patients were younger, more frequently female, and had lower NIHSS scores compared to NVD patients. Specific symptoms like vertigo and headache were more common in SM, while motor deficits and speech issues were more prevalent in NVD.

Conclusions:

• Stroke mimics constitute a significant proportion (38%) of suspected acute stroke cases, underscoring diagnostic difficulties.
• The use of cerebral MRI as a primary diagnostic tool is valuable for distinguishing NVD from SM in patients presenting with acute neurological symptoms.
• Optimizing stroke care pathways requires accurate differentiation between true strokes and stroke mimics.