Higher risk for elevated PTSD symptoms in patients with stroke mimics versus confirmed stroke or TIA

Stroke mimics, which resemble true strokes or transient ischemic attacks (TIAs), are common in emergency departments (EDs) and carry lower physical health risks, but their mental health impact is unknown. This study compared the risk for elevated post-traumatic stress disorder (PTSD) symptoms in patients with stroke mimics versus those with confirmed stroke or TIA.

We enrolled 1000 ED patients with suspected stroke/TIA into a prospective cohort and categorized them as stroke mimics or stroke/TIA. At 1-month follow-up, PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Adjusted odds of elevated 1-month PTSD symptoms (PCL-5 ≥ 33) by diagnostic category (mimic, stroke or TIA) were estimated with logistic regression.

Of 949 analyzed patients (excluding those with equivocal diagnosis), 8.4% screened positive for elevated 1-month PTSD symptoms. The rate was higher in patients with mimic (13.5%) than in those with confirmed stroke or TIA (6.4%). Adjusting for demographics, stroke severity, functional status at discharge, and baseline PTSD symptoms due to prior traumatic events, risk of elevated 1-month PTSD symptoms attributed to suspected stroke/TIA was higher after mimic events versus stroke/TIA (OR = 2.61, 95% CI [1.35, 5.05], p < .01).

Elevated PTSD symptoms were surprisingly more common after stroke mimics than confirmed stroke/TIA, despite the distress of stroke/TIA. Because patients with severe stroke were not enrolled, PTSD risk in the stroke/TIA group may have been underestimated. Research on the behavioral and clinical consequences of mimic-related distress is warranted, and PTSD screening and treatment should be considered.