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[Metabolic insult causing re-expression of old stroke (MICROS) presenting as stroke mimics]
Tomoaki Kameda1, Shunichi Okada1, Kohei Furuya1
1Department of Neurology, Shin-Oyama City Hospital.
Background:
Metabolic insult causing re-expression of old stroke (MICROS), one of the stroke mimics, is characterized by reappearance of impairment of past stroke and can be mistaken for a stroke recurrence. The aim of the present study was to identify the clinical characteristics of MICROS in emergency stroke care, and to investigate predictive factors for distinguishing MICROS from stroke recurrences.
Methods:
In our Stroke Center, 519 consecutive patients admitted with suspected stroke in June 2016 to December 2017. MICROS was defined as an acute deterioration of neurological deficits of the previous stroke despite no evidence for stroke recurrences. Among the 70 patients with a past history of stroke, 14 were MICROS, 5 were transient ischemic attack, 15 were other stroke mimics, and 36 were stroke recurrences, respectively. We evaluated the clinical characteristics of MICROS and compared MICROS with stroke recurrences.
Results:
The causes of MICROS were infectious disease (including influenza and pneumonia) in 4, transient somnolence after syncope in 4, hypo/hyperglycemia in 2, medication overdoses in 1, and anxiety in 3. Eight of the 14 MICROS patients were admitted within 4 hours after the symptom onset. In MICROS patients, fever (>37°C) was observed more frequently than those with stroke recurrences though the difference was not statistically significant.
Conclusion:
MICROS might be associated with fever, syncope, or serum glucose abnormality. MICROS patients sometimes visit the hospital emergency room within 4 hours, thus, distinction between MICROS and true stroke recurrences is important.
Insights
Metabolic insult causing re-expression of old stroke (MICROS) can mimic a true stroke recurrence. Identifying MICROS involves recognizing symptoms like fever, syncope, or glucose abnormalities, crucial for accurate emergency stroke care.
Area of Science:
- Neurology
- Emergency Medicine
- Stroke Research
Background:
- Metabolic insult causing re-expression of old stroke (MICROS) presents as a reappearance of prior stroke deficits, often mistaken for recurrent stroke.
- Distinguishing MICROS from actual stroke recurrence is critical in emergency settings.
Purpose of the Study:
- To identify clinical characteristics of MICROS in emergency stroke care.
- To investigate predictive factors for differentiating MICROS from stroke recurrences.
Main Methods:
- Retrospective analysis of 519 suspected stroke patients admitted between June 2016 and December 2017.
- Defined MICROS as acute neurological deterioration mirroring past stroke without evidence of recurrence.
- Compared clinical features of 14 MICROS patients with 36 stroke recurrence patients.
Main Results:
- Common causes of MICROS included infections (influenza, pneumonia), syncope, hypoglycemia/hyperglycemia, medication overdose, and anxiety.
- Fever was more frequent in MICROS patients than in stroke recurrences, though not statistically significant.
- MICROS patients were sometimes admitted within 4 hours of symptom onset.
Conclusions:
- MICROS may be associated with fever, syncope, or serum glucose abnormalities.
- Early presentation to the emergency room within 4 hours is observed in some MICROS cases.
- Accurate distinction between MICROS and stroke recurrence is essential for appropriate patient management.
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