Is it a stroke or does it just present like one?

Ischemic stroke vs. stroke mimics and stroke chameleons

Ischemic stroke is the among the leading causes of death in the United States, but so-called stroke mimics and stroke chameleons also can be deadly. At a recent presentation, Bryan J. Eckerle, M.D., neurologist with Norton Neuroscience Institute, discussed the differences.

“A stroke mimic initially presents like an acute ischemic stroke, but the final diagnosis ends up being something else,” Dr. Eckerle said. “Stroke chameleons are the opposite. Patients present with symptoms that aren’t classically consistent with stroke, but they have a final diagnosis of acute stroke.”

Why should physicians be aware of the different types of stroke and their relatives?

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“Stroke mimics are exceedingly common,” Dr. Eckerle said. “About 25% of stroke referrals are mimics. Knowing differences here affects tPA [tissue plasminogen activator,  a clot-busting stroke drug] decision-making and allows us to deliver cost-effective and consistently clinically sound care.”

Stroke mimic

These are symptoms that might signal stroke, but also might signal a stroke mimic:

  • Seizure
  • Migraine
  • Metabolic disarray (particularly hypoglycemia)
  • Mass lesions
  • Encephalopathy
  • Functional disorders

Diagnosing a stroke mimic

“There are virtually no absolutes or ‘always’ in neurology,” Dr. Eckerle said. “Typically, we might use anything from an MRI to eye-movement testing to EEG [electroencephalogram], but the key is to look at the big picture and test carefully.”

Stroke chameleon

Stroke chameleons are perhaps the more difficult of these two groups to diagnose and often pose missed opportunities for acute care, according to Dr. Eckerle.

“It is possible for an acute stroke to present with symptomatic seizure,” Dr. Eckerle said. “But just having a seizure is not enough to say there is no stroke present.”

See Dr. Eckerle’s full presentation here.


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