Frequency and Outcomes of Patients with Misdiagnosed Acute Stroke

Seemant Chaturvedi, MD reviewing Richoz B et al. Neurology 2015 Aug 11.

Younger patients were more likely to have a missed stroke diagnosis in a registry analysis.

Acute ischemic stroke can be a challenging diagnosis due to the plethora of possible neurological symptoms and signs and the fact that radiologic studies (especially computed tomography) may be negative in the first hours. Consequences of a missed stroke diagnosis have not received much attention. These authors retrospectively analyzed 2200 patients from the Lausanne Acute Stroke Registry, of whom 47 (2.1%) were initially misdiagnosed.

Patients with an initial misdiagnosis were likely to be younger and to have lower diastolic blood pressure. Clinical features that were significantly more common in misdiagnosed patients than in correctly diagnosed stroke patients were lack of eye deviation (odds ratio, 0.21) and cerebellar stroke (OR, 3.78). Of the misdiagnosed patients, 43% were thought to have a different neurological condition, 17% had their symptoms attributed to nonneurological causes, and 21% had an unexplained decrease in level of consciousness. In retrospect, 23.4% of misdiagnosed patients were judged to be potential thrombolysis candidates. Patients with an initial misdiagnosis were less likely to achieve a good neurologic outcome at 12 months and had significantly higher 12-month mortality (30.4% vs. 19.4%; adjusted OR, 4.37).

Citation(s):

Richoz B et al. Acute stroke chameleons in a university hospital: Risk factors, circumstances, and outcomes. Neurology 2015 Aug 11; 85:505.