Acute Ischemic Stroke Mimics and Chameleons


Judita Petro1, Justas Krištopaitis1, Kamilė Račkelytė1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Stroke misdiagnosis is a major health care concern. The rate of stroke misdiagnosis is about 9% of all stroke patients in the emergency setting. Ischemic stroke most commonly presents with focal neurologic deficit within a specific vascular distribution. However, many conditions mimic the presentation of stroke and account for up to 25% of admissions for probable strokes. Stroke mimics are conditions that present with stroke-like symptoms, but a diagnosis of stroke at admission is not confirmed, and a stroke chameleon is a situation in which a stroke is revealed by clinical symptoms that are not usual in stroke. Under- or missed diagnosis of stroke can result in adverse patient outcomes due to unnecessary treatment and failure to initiate secondary prevention strategies. The safety profile of intravenous thrombolysis (IVT) in patients who have stroke mimics is excellent and intracranial hemorrhages are rare. Modern neuroimaging techniques help to identify most mimics. The problem with chameleons is more serious, because patients are not identified, and are not properly treated. The role of imaging for stroke chameleons may be less important, especially when the clinical presentation is not suggestive of a brain disorder that requests immediate neuroimaging. The education of health providers to identify such situations is crucial. The purpose of this review is to identify the most frequent stroke mimics, chameleons and consequences for the patient.

Keywords:  misdiagnosis, ischemic stroke, stroke chameleon, stroke mimic