Dear Reader,

Part 2 – Stroke Mimics

In part 1, we reviewed the classification of strokes as Disabling vs Non Disabling and how it affects treatment approach.

In part 2, we review common stroke mimics.

Stroke miss rate and mimics – the 10% rule

Emergency physicians miss approximately 1 in 10 strokes. Short term morbidity and mortality are 8 fold higher in missed strokes. Conversely, a similar proportion of “strokes” turn out to be mimics. Recognizing the difference is critical for avoiding both under- and overtreatment.

Common stroke mimics

• Peripheral vestibular disease (vertigo)
• Metabolic or toxic states (hypo/hyperglycemia, hyponatremia)
• Seizures and post-ictal paresis (Todd’s paralysis)
• Atypical migraine
• Functional neurological disorder (FND)

General Features Which Help Differentiate Stroke vs Stroke Mimics

Pearls

• Check capillary glucose early—hypoglycemia can mimic stroke.
• Always walk test and check truncal ataxia; missed posterior strokes often result from incomplete cranial nerve and gait testing.

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This was just one nugget. There are lots more to learn from the podcast.
To listen to the podcast click here: https://emergencymedicinecases.com/nondisabling-strokes-recognition-management/​

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​This Just The Nuggets was Created by Matthew McArthur, Elliot Lee & Anton Helman based on the EM Cases Written Summary by Anton Helman. Please send us your feedback here.

Dr. Anton Helman & The EM Cases Team

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