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Functional Stroke Mimics: Patient Characteristics, CT-Based Multimodal Imaging and Long-Term Outcome in a Comparative
Filipa Bastos1, Davide Strambo1, Alexander Salerno1
1Stroke Centre, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
European Journal of Neurology
|May 6, 2026
Summary
Functional stroke-like episodes (FSMs) mimic strokes but have different patient profiles and normal imaging. Long-term outcomes show persistent disability and recurrent events, indicating a need for better treatments.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Mimics
Background:
- Functional stroke-like episodes (FSMs) are recognized stroke mimics.
- FSMs present distinct demographics and clinical features compared to acute ischemic strokes (AISs).
- Long-term outcomes for FSMs remain unclear.
Purpose of the Study:
- To characterize demographic and clinical features of FSMs.
- To compare FSMs with AISs using perfusion-CT (PCT).
- To evaluate long-term outcomes of FSMs.
Main Methods:
- Retrospective analysis of FSM patients undergoing acute PCT (2003-2017).
- Comparison with contemporaneous AIS patients undergoing PCT from the ASTRAL registry.
- Propensity-score-matched analysis for 3-month outcomes.
Main Results:
- FSM patients were younger (median 43 vs. 73 years) with higher rates of psychiatric disorders.
- FSMs showed normal CT and PCT imaging, with similar acute revascularization rates to AIS.
- At 3 months, handicap rates were similar, but FSM mortality was lower.
- Long-term follow-up (median 9 years) revealed no functional improvement and 55% experienced recurrent events.
Conclusions:
- FSMs have unique features: younger age, psychiatric comorbidities, and normal neuroimaging.
- Despite normal imaging, FSMs have significant long-term disability and recurrent events.
- Effective treatments and regular follow-up are needed for FSM patients.
