Diagnosis and Misdiagnosis of Cerebrovascular Disease
Author:
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine
Link
http://link.springer.com/content/pdf/10.1007/s11936-013-0233-x.pdf
Reference53 articles.
1. Norris JW, Hachinski VC. Misdiagnosis of stroke. Lancet. 1982;1:328–31. This is a reference to a study performed on 821 patients admitted to an acute stroke unit that evaluated the frequency and causes of misdiagnosis of stroke. The study found that the initial diagnosis of stroke was incorrect in 13% of patients, and the most common causes were seizures, confusional states, and syncope. This study demonstrated the importance of clinical skill in making a correct diagnosis, with accuracy ranging from 38% to 89%.
2. Artto V, Putaala J, Strbian D, Meretoja A, Piironen K, Liebkind R, et al. Stroke mimics and intravenous thrombolysis. Ann Emerg Med. 2012;59:27–32.
3. Hemmen TM, Meyer BC, McClean TL, Lyden PD. Identification of nonischemic stroke mimics among 411 code strokes at the University of California, San Diego, Stroke Center. J Stroke Cerebrovasc Dis. 2008;17:23–5.
4. Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37:769–75. This is an observational, prospective study carried out in an urban teaching hospital with a 16-bed stroke unit and access to typical laboratory and imaging investigations necessary for a thorough stroke workup. The authors sought to identify the frequency of stroke mimics and bedside pointers to the diagnosis of stroke. Three hundred-fifty consecutive presentations of “brain attack” suspicious for acute stroke were studied. A definitive non-stroke diagnosis was made in 19% of cases. Seizure was the most frequent mimic (21.1%). Clinical, bedside pointers to stroke diagnosis included severe deficit (especially NIHSS >10), exact time of symptom onset, lateralization of neurologic symptoms, and signs and presence of cardiovascular risk factors in the appropriate clinical context. Those were identified after multivariate analyses.
5. Kothari RU, Brott T, Broderick JP, Hamilton CA. Emergency physicians. Accuracy in the diagnosis of stroke. Stroke. 1995;26:2238–41. This refers to a study of 446 patients who were evaluated in the emergency department at a large urban teaching hospital with a comprehensive stroke intervention program, and admitted for provisional diagnosis of ischemic or hemorrhagic stroke. It showed a sensitivity of ER physician diagnosis of ischemic stroke or TIA to be 98.6% with positive predictive value of 94.8%. ER physicians were able to diagnose intracerebral or subarachnoid hemorrhage correctly with a sensitivity of 100% and positive predictive value of 100%. Inclusion of ER physicians as part of the acute stroke team and providing phone or telemedicine consultation can improve diagnostic accuracy in the ER. Facilities with a comprehensive stroke intervention program with increased education and awareness among emergency staff, can improve diagnostic accuracy and subsequently outcomes.
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