Identification of Stroke Mimics among Clinically Diagnosed Acute Strokes
Lojana Tuntiyatorn MD*, Pichaya Saksornchai MD*, Supoch Tunlayadechanont MD**
Affiliation : * Division of Neuroradiology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Division of Neurology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics
is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since
treatment plan may differ.
Objective : To determine the incidence of the stroke mimics and identify their etiologies.
Material and Method: All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received
imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month
period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical
follow-up records were reviewed for final diagnosis.
Results : Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with
range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.4%) were hemorrhagic
stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were
metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage
(14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.3%), central nervous system infection (5, 2.7%), others (26, 14.0%), and
unspecified (16, 8.6%).
Conclusion : Incidence rates and etiologies of the stroke mimics were similar to the western reports. However, the frequency
of each mimic was not.
Keywords : Acute strokes, Ischemic stroke, Hemorrhagic stroke, Stroke mimics, Computed tomography
