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Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Emma J C Wallace1, Ava L Liberman1

  • 1Montefiore Medical Center, Albert Einstein College of Medicine, Department of Neurology, Bronx, NY, USA.

Neuropsychiatric Disease and Treatment
|May 21, 2021
PubMed

Insights

Timely diagnosis of transient ischemic attack (TIA) and stroke is crucial. This study highlights common and atypical stroke symptoms, offering strategies to reduce diagnostic errors in outpatient settings.

Area of Science:

  • Neurology
  • Diagnostic Medicine
  • Public Health

Background:

  • Delayed diagnosis of transient ischemic attack (TIA) and stroke leads to severe patient outcomes.
  • Outpatient settings are particularly susceptible to missed diagnoses of cerebrovascular events, especially with atypical presentations.

Purpose of the Study:

  • To identify common and atypical stroke presentations that may be misdiagnosed.
  • To review diagnostic error reduction strategies in outpatient care.
  • To emphasize timely stroke specialist consultation and diagnostic time-outs.

Main Methods:

  • Review of common and atypical stroke chameleon symptoms.
  • Exploration of new developments in diagnostic error research.
  • Proposal of practical clinical strategies for error reduction.
  • Discussion of the role of psychiatric disease and vascular risk factors.

Main Results:

  • Patients with minor, transient, or atypical cerebrovascular disease symptoms are at higher risk for delayed diagnosis.
  • Diagnostic errors in stroke/TIA can be mitigated through specific clinical strategies.
  • Incorporating diagnostic time-outs can improve diagnostic accuracy.

Conclusions:

  • Recognizing subtle and atypical stroke symptoms is vital for timely diagnosis.
  • Implementing diagnostic time-outs and specialist consultations can significantly reduce morbidity and mortality associated with stroke and TIA.
  • Further research into diagnostic error in outpatient settings is warranted.

Keywords:
cerebrovascular diseasediagnostic errorstrokestroke chameleons

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